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8 

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6


z¤wž‹ÙŸw

 ĢüġĐâĕčúĘħčĄĕåĄğăčĔëâĆĆĄëěĄëü þĆēğúċģúą  ĄĘĐĕąěåĆý  þĿĢüþĿüĘĨĎĆĚĐĎüęħèúċĊĆĆČúĘħâĬĕĈĔèéē ÿŇĕüāňüģþĢüþĿüĘĨ åöēâĆĆĄâĕĆĒ ģ÷ňéĔ÷âĕĆþĆēëěĄĢĎîŇ ö ċĜüąŋüėúĆĆċâĕĆĠĈēâĕĆþĆēëěĄģýğúå ýĕèüĕ ĐąŇĕèąėħèĢĎîŇãęĨüĐĘâåĆĔĨèĎüęħèĠĈēĠøâøŇĕèéĕâþĿúĘħÿŇĕüĄĕğāĆĕēüĐâéĕââĕĆþĆēëěĄøĕĄĊĕĆēčĕĄĔîþĆēéĬĕþĿĐĔü ģ÷ňĠâŇ âĕĆĠùĈèÿĈèĕüĢüĆĐýþĿúĘħÿŇĕüĄĕâėéâĆĆĄøŇĕèĥúĘħúĬĕãęĨüăĕąĢøňâĕĆúĬĕèĕüãĐèâĆĆĄâĕĆčĄĕåĄĒĀłĕą øŇĕèĥúĬĕĢĎňèýĆĕąéŇĕąãĐèčĄĕåĄĒĄĘâĕĆÿĔüÿĊüğþŎüĐĔüĄĕâéĕâþĿúĘħÿŇĕüĥĄĕĐĔüğþŎüÿĈĄĕéĕââĕĆğýėâéŇĕą úĘħĐĕéĈŇĕëňĕğüĚħĐèéĕâğþŎüĎüŇĊąĆĕëâĕĆğëŇüâėéâĆĆĄâĕĆĈèğąĘħąĄýňĕüãĐèġåĆèâĕĆğăčĔëâĆëěĄëüğąĘħąĄýňĕüìęħè ğþŎüâėéâĆĆĄéĔ÷éňĕèéĕâúĕèčĬĕüĔâĎĈĔâþĆēâĔüčěãăĕāĠĎŇèëĕøė čþčë  ăĕąĢøňâĕĆþĆēčĕüåĊĕĄĆŇĊĄĄĚĐéĕâ čĄĕåĄĒąĔèĄĘâĕĆþĆēâĊ÷ÿĈèĕü÷Ęğ÷ŇüúĘħğâĘħąĊâĔýĊėëĕëĘāğăčĔëâĆĆĄëěĄëüùęèčĐèþĆēğăú÷ňĊąâĔüĐĔüģ÷ňĠâŇ ÿĈ èĕüĊėéĔą÷Ęğ÷Ňü÷ňĕüğăčĔëâĆĆĄëěĄëüĠĈēâĕĆþĆēâĊ÷čě÷ąĐ÷ğăčĔëâĆëěĄëüĆěŇüĢĎĄŇåĆĔĨèúĘħ  þĆēéĬĕþĿ  Ģü ĎĔĊãňĐĆňĕüąĕĢüĀŌüìęħèğþŎüÿĈèĕüãĐèüėčėøğăčĔëúĘħÿŇĕüâĕĆåĔ÷ğĈĚĐâéĕâĄĎĕĊėúąĕĈĔąøŇĕèĥ ĄĕĠĈňĊ ĆŇĊĄâĔýâĕĆ þĆēâĕċÿĈâĕĆğĈĚĐâøĔĨèāĆňĐĄĠüēüĬĕåöēâĆĆĄâĕĆëě÷ĢĎĄŇ  úŇĕü âĕĆýĆĆąĕąāėğċČúĘħčĬĕåĔîĢüĆĜþĠýý âĕĆĐăėþĆĕąĢüĎĔĊãňĐ ÁąěúûċĕčøĆŋâĕĆāĔõüĕĊėëĕëĘāğăčĔëâĆĆĄëěĄëüĢüúċĊĆĆČĎüňĕ ìęħèğþŎüĎĔĊãňĐúĘħ ğăčĔëâĆëěĄëüģĄŇåĊĆāĈĕ÷ĢüĊĔüĐĕúėøąŋúĘħĄĘüĕåĄ  ĢüġĐâĕčúĘħÿĄâĬĕĈĔèéēāňüéĕâøĬĕĠĎüŇèğĆĦĊĥ üĘĨ ÿĄãĐãĐýåěöåöēâĆĆĄâĕĆĒ ĠĈēčĄĕëėâúěâúŇĕüúĘħĢĎň âĕĆčüĔýčüěüĄĕğþŎüĐąŇĕè÷Ęġ÷ąøĈĐ÷ ùęèĠĄňþŌîĎĕĢüĊėëĕëĘāãĐèğĆĕéēĄĘĄĕâĄĕąğāĘąèĢ÷âĦøĕĄ ÿĄåė÷ĊŇĕ āĊâğĆĕčĕĄĕĆùĀłĕĂŌüģþģ÷ňģĄŇąĕâüĔâĎĕâāĊâğĆĕĆŇĊĄĠĆèĆŇĊĄĢéâĔüĠĈēāĔõüĕâĕĆúĬĕèĕüãĐèāĊâğĆĕĢĎňúĔü ąěåčĄĔąãöēğ÷ĘąĊâĔüøňĐèĎĄĔħüğĆĘąüĆĜňčėħèĢĎĄŇĥúĘħğâė÷ãęĨüĠĈēþĆĔýĄĕĢëňĢüâĕĆúĬĕèĕüéĆėè  âĕĆğþŎüčĄĕëėâčĄĕåĄĒğþŎüĎüúĕèĎüęħèúĘħúĬĕĢĎňčĄĕëėâúěâúŇĕüģ÷ňĆĔýčėħèğĎĈŇĕüĘĨ ãňĐğčüĐĠüēãĐèčĄĕëėâ úěâåüéēğþŎüþĆēġąëüŋøŇĐâĕĆ÷ĬĕğüėüèĕüãĐèčĄĕåĄĒ ÿĄĎĊĔèğþŎüĐąŇĕèąėħèĊŇĕĢüúċĊĆĆČøŇĐģþìęħèğþŎüëŇĊèúĘħéē ĄĘåĊĕĄğþĈĘħąüĠþĈèĐąŇĕèĆĊ÷ğĆĦĊĠĈēĄĕâĄĕąüĔĨüéēģ÷ňĆĔýåĊĕĄĆŇĊĄĄĚĐéĕâúěâåüĄĕâąėħèãęĨüģþĠĈēġþĆ÷ĐąŇĕ ĈĚĄĊŇĕčĄĕåĄĒğþŎüãĐèāĊâğĆĕúěâåü ÷ňĊąåĊĕĄþĆĕĆùüĕ÷Ę ăâûĘĆĊěõėāèċŋğċĆČòģāċĕĈ üĕąâčĄĕåĄğăčĔëâĆĆĄëěĄëü þĆēğúċģúą

7


’‹ ƒ„ošj•o

’‰šl‰¤ˆ’™ri‹‹‰r ‰r (ƒ‹˜¤¨Š) §‹•‚ƒÊ 2553

ĢüĆĐýþĿ ā.ċ.2553 úĘħÿŇĕüĄĕ üĔýğþŎüĐĘâþĿĎüęħèúĘħčĄĕåĄğăčĔëâĆĆĄëěĄëü (þĆēğúċģúą) ģ÷ňĠč÷èýúýĕúĢü òĕüēĐèåŋâĆĎüęħèãĐèĊėëĕëĘāğăčĔëâĆĆĄ ĆŇĊĄāĔõüĕýúýĕúãĐèĊėëĕëĘāğăčĔëâĆĆĄĢĎňğþŎüúĘħþĆēéĔâČŋĄĕâąėħèãęĨü ĆėğĆėħĄ āĔõüĕġåĆèâĕĆ éĔ÷âėéâĆĆĄøŇĕèĥ ğāĚħĐčĄĕëėâĠĈēâėéâĆĆĄğāĚħĐčĕûĕĆöþĆēġąëüŋ ġ÷ąģ÷ňĆĔýåĊĕĄĆŇĊĄĄĚĐĠĈēâĕĆ čüĔýčüěüĐĔü÷ĘéĕâĐèåŋâĆĎüŇĊąèĕüúĔĨèăĕåĆĔòĠĈēğĐâëüøŇĕèĥ ġ÷ąčĕĄĕĆùčĆěþÿĈèĕü ĠýŇèøĕĄĀłĕąøŇĕèĥ ãĐè čĄĕåĄĒ ģ÷ň÷ĔèüĘĨ • …ÍšŠ’‰šrœi’™‰†™€Ö : ãňĐĄĜĈ ö ĊĔüúĘħ 31 ûĔüĊĕåĄ 2553 ĄĘčĄĕëėâúĘħøė÷øŇĐģ÷ňúĔĨèčėĨü 3,164 åü (éĬĕüĊü čĄĕëėâúĔĨèĎĄ÷ 3,334 åü) éĬĕüĊüčĄĕëėâúĘħčĄĔåĆĢĎĄŇĢüþĿ 2553 éĬĕüĊü 101 åü ãňĐĄĜĈčĄĕëėâĠč÷èĠąâøĕĄăĜĄėăĕå þĆēğăúèĕüøŇĕèĥ ĠĈēčùėøėéĬĕüĊüčĄĕëėâčĄĕåĄĒ úĘħğāėħĄãęĨü ÷ĔèĠč÷èĢüĠÿüăĜĄėøŇĐģþüĘĨ

• …ÍšŠœršiš‹  Š âĕĆéĔ÷þĆēëěĄĊėëĕâĕĆþĆēéĬĕğ÷ĚĐü ĠĈēâĕĆéĔ÷þĆēëěĄğëėèþñėýĔøėâĕĆ : ĢüþĿ 2553 čĄĕåĄĒ ģ÷ňéĔ÷ þĆēëěĄ 15 åĆĔĨè ğþŎüâĕĆþĆēëěĄĊėëĕâĕĆ 13 åĆĔĨè, þĆēëěĄğëėèþñėýĔøėâĕĆ 1 åĆĔĨè ĠĈēþĆēëěĄĢĎîŇ 1 åĆĔĨè ġ÷ąĄĘúĔĨèâĕĆ þĆēëěĄúĘħčĄĕåĄĒ éĔ÷ãęĨüĠĈēĆŇĊĄĄĚĐâĔýĎüŇĊąèĕüĐĚħüĥ ÷ĔèčĆěþĢüøĕĆĕè÷ĔèüĘĨ 8


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 ™âĕĆéĔ÷úĬĕĊĕĆčĕĆğăčĔëâĆĆĄëěĄëü ğāĚħĐğÿąĠāĆŇãňĐĄĜĈãŇĕĊčĕĆĢüĠĊ÷ĊèĊėëĕëĘā ĆĊĄúĔĨèüĬĕğčüĐğüĚĨĐĎĕ úĘħúĔüčĄĔąúĕèĊėëĕâĕĆğâĘħąĊâĔýġĆå ąĕ âĕĆĆĔâČĕ âĕĆ÷ĜĠĈčěãăĕā ĠĈēâĕĆĢëňÿĈėøăĔöôŋčěãăĕāøŇĕèĥ ġ÷ąğÿąĠāĆŇ ĊĕĆčĕĆģþąĔèčĄĕëėâĠĈēĎüŇĊąèĕüúĘħğâĘħąĊãňĐèøŇĕèĥ þĿĈē 6 êýĔý (ĐĐâúěâ 2 ğ÷ĚĐü) • …ÍšŠ’ï•’š‹•olÖi‹ (ƒ‹˜rš’™‰†™€Ö)  ™ čĄĕåĄĒ ģ÷ňúĕĬ âĕĆþĆēëĕčĔĄāĔüûŋğâĘąħ ĊâĔýĊėëĕëĘāğăčĔëâĆĆĄ ĠĈēĊėëĕëĘāğăčĔëâĆĆĄëěĄëüġ÷ąþĆēëĕčĔĄāĔüûŋ ÿŇĕüčĚħĐ 3 ëŇĐèúĕè ÷ĔèüĘĨåĚĐ - þĆēëĕčĔĄāĔüûŋÿŇĕüúĕèğĊĦýģìøŋ www.pharcpa.com - þĆēëĕčĔĄāĔüûŋãŇĕĊčĕĆĠĈēåĊĕĄĆĜňúĕèĊėëĕëĘāÿŇĕüúĕèĊĕĆčĕĆğăčĔëâĆĆĄëěĄëü - ĢĎňåĊĕĄĆĜňúĕè÷ňĕüâĕĆĢëňąĕ ĠĈēâĕĆĆĔâČĕčěãăĕā ÿŇĕüúĕèĆĕąâĕĆĊėúąěĠĈēğåğýėĈúĘĊĘ ġ÷ąâĆĆĄâĕĆãĐè čĄĕåĄĒ ğþŎüÿĜň÷ĬĕğüėüĆĕąâĕĆĠĈēğþŎüĊėúąĕâĆĆĔýğëėîĢüĆĕąâĕĆøŇĕèĥ ÷ĔèüĘĨ - ĊėúąĕâĆĆĔýğëėîĆĕąâĕĆëĘĊėøč÷ĢčêĈĕ÷Ģëňąĕ ëŇĐè 9 ĐčĄú. (10 øĐü) - ĆĕąâĕĆĎüĘĨĠÿŇü÷ėü čěãăĕā÷ĘâĔýāĆĘĄŇĕ úĕè True vision 8 ĠĈē TNN 2 (3 øĐü) - ĆĕąâĕĆčĕąĢąčěãăĕā úěâĊĔüğčĕĆŋ ğĊĈĕ 20.00-21.45 ü. ëŇĐè P5TV - úĕèåĈĚħüĊėúąě : FM 89.5, FM 95.75, FM 98.75, FM 103, AM 1143, éč.100  ™ čĄĕåĄĒ éĔ÷ġåĆèâĕĆþĆēâĊ÷čĚħĐþĆēëĕčĔĄāĔüûŋ ĎĔĊãňĐ “ğĄĚħĐģĎĆŇéēğãňĕĢéìēúĘ...ĊŇĕĆňĕüąĕøňĐèĄĘğăčĔëâĆ” ğāĚħĐĎĕčĚħĐþĆēëĕčĔĄāĔüûŋúĘħ÷ęè÷Ĝ÷ĠĈēğĎĄĕēčĄúĘħéēčĕĄĕĆùâĆēøěňüĢĎňþĆēëĕëüğâė÷åĊĕĄøĆēĎüĔâùęèåĊĕĄčĬĕåĔîãĐè ğăčĔëâĆëěĄëü  ™ čĄĕåĄĒ éĔ÷ĢĎňĄĘāėûĘâĕĆĠĈēâėéâĆĆĄĢüĊĔüĠĄŇĠĈēĊĔüāŇĐ ġ÷ąĢĎňčĄĕëėâúĘħĄĕĆŇĊĄâĕĆþĆēëěĄĊėëĕâĕĆþĆēéĬĕ ğ÷ĚĐüčėèĎĕåĄĠĈēûĔüĊĕåĄ ĆŇĊĄúĬĕâėéâĆĆĄğúė÷āĆēğâĘąĆøėĠĈēâĕĆĆēĈęâùęèāĆēåěöýė÷ĕĄĕĆ÷ĕĠĈēÿĜňĐĕĊěġčĢüĠĊ÷Ċè ĊėëĕëĘā Đĕúė âĕĆĆňĐèğāĈèč÷ě÷ĘĄĎĕĆĕëĕ ĐŇĕüâĈĐüğúė÷āĆēğâĘąĆøė ĠĈēâĕĆĄĐýāĊèĄĕĈĔą÷ĐâģĄňĠâŇøĔĊĠúüåěöāŇĐ åěöĠĄŇĠĈēÿĜňĐĕĊěġč  ™ čĄĕåĄĒ ĆŇĊĄâĔýĄĜĈüėûėğăčĔëâĆĆĄëěĄëü éĔ÷ġåĆèâĕĆþĆēâĊ÷čě÷ąĐ÷ğăčĔëâĆëěĄëüĆěŇüĢĎĄŇĠĈēġåĆèâĕĆ þĆēâĊ÷èĕüĊėéĔąğăčĔëâĆĆĄëěĄëü ğāĚħĐĢĎňğăčĔëâĆ åöĕéĕĆąŋĠĈēüĔâċęâČĕğăčĔëċĕčøĆŋ čĆňĕèčĆĆåŋĠüĊåė÷ ÿĈèĕüĠĈē èĕüĊėéĔąúĘħéēúĬĕĢĎňğâė÷âĕĆāĔõüĕĢüĊėëĕëĘāčĕãĕğăčĔëâĆĆĄëěĄëüĄĕâãęĨü  ™ čĄĕåĄĒ ĆŇĊĄâĔýğåĆĚĐãŇĕąĊėëĕëĘāğăčĔëâĆĆĄğāĚħĐâĕĆåĊýå쥹ĕčĜý ĆöĆèåŋþĆēëĕčĔĄāĔüûŋġåĆèâĕĆğăčĔë ĐĕčĕāĕğĈėâýěĎĆĘħÿŇĕüčĚħĐĊėúąě FM 89.5, FM 95.75, FM 103, AM 1143, éč.100 ĠĈēğåğýėĨĈúĘĊĘ P5 ğāĚħĐčĆňĕèâĆēĠč ĆöĆèåŋĢĎňþĆēëĕëüğĈėâýěĎĆĘħ ĠĈēâĆēøěňüğăčĔëâĆĎĆĚĐÿĜňþĆēâĐýâĕĆĆňĕüąĕğãňĕĄĕëŇĊąğĎĈĚĐĎĆĚĐčŇèøŇĐÿĜňúĘħøňĐèâĕĆğĈėâ ýěĎĆĘħĄĕâãęĨü • …ÍšŠ†™zš‚‚š‹ÓšŠš  ™ ġåĆèâĕĆ÷ĜĠĈþŌîĎĕéĕââĕĆĢëňąĕĢüÿĜňþłĊąğêāĕēĆĕąĢüëěĄëü ğãøāĚĨüúĘħâĆěèğúāĄĎĕüåĆ ĎĆĚĐğăčĔëâĆ ëěĄëüğąĘħąĄýňĕü čüĔýčüěüġ÷ąčĬĕüĔâèĕüĎĈĔâþĆēâĔüčěãăĕāĠĎŇèëĕøė (čþčë.) ğãø 13 âĆěèğúāĄĎĕüåĆ Ġč÷èĢĎň ğĎĦüùęèýúýĕúãĐèğăčĔëâĆëěĄëüĢüýúýĕúğëėèĆěâčĜŇþĆēëĕëü ğāĚħĐčŇèğčĆėĄåĊĕĄĆŇĊĄĄĚĐãĐèÿĜňþłĊąĢüâĕĆĢëňąĕĢĎňğâė÷ þĆēčėúûėÿĈ øĔĨèĠøŇþĿ ā.ċ. 2551 éüùęèþŌééěýĔü éĬĕüĊüÿĜňþłĊąúĘħğąĘħąĄ þĆēĄĕö 1,700 Ćĕą 100 ëěĄëü úĔħĊâĆěèğúāĄĎĕüåĆ

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ĆŇĊĄĄĚĐâĔýâĐèúěüġĈâ (Global Fund) ăĕąĢøňġåĆèâĕĆ Corporate Champion Program ÷Ĭĕğüėü âĕĆøŇĐğüĚħĐè ğāĚħĐĈ÷âĕĆĠāĆŇĆēýĕ÷ãĐèÿĜňøė÷ğëĚĨĐğĐ÷čŋ ġ÷ąéĔ÷ĎĕĆňĕüąĕĢüĠĎĈŇèëěĄëüğãňĕĆŇĊĄġåĆèâĕĆğāĚħĐëŇĊąĠéâ éŇĕąğãĦĄêĘ÷ąĕĠĈēùěèąĕèĐüĕĄĔąĢĎňĠâŇÿĜňþłĊąúĘħčĕĄĕĆùğãňĕùęèģ÷ň  ™ čĄĕåĄĒ ĆŇĊĄâĔýğåĆĚĐãŇĕąĊėëĕëĘāğăčĔëâĆĆĄğāĚħĐâĕĆåĊýå쥹ĕčĜý (ğăčĔëĐĕčĕāĕğĈėâýěĎĆĘħ) ĆŇĊĄĆöĆèåŋ þĆēëĕčĔĄāĔüûŋġåĆèâĕĆğăčĔëĐĕčĕāĕğĈėâýěĎĆĘħ ĠĈēâĆēøěňüĢĎňğăčĔëâĆĎĆĚĐÿĜňþĆēâĐýâĕĆĆňĕüąĕğãňĕĄĕëŇĊąğĎĈĚĐĎĆĚĐčŇè øŇĐÿĜňúĘħøňĐèâĕĆğĈėâýěĎĆĘħĄĕâąėħèãęĨü  ™ čĄĕåĄĒ čŇèÿĜňĠúüĠĈēğëėîëĊüčĄĕëėâéĬĕüĊüĎüęħè ğãňĕĆŇĊĄéĔ÷âėéâĆĆĄâĕĆĢĎňåĬĕþĆęâČĕ÷ňĕüąĕĠĈēčěãăĕā ĠâŇþĆēëĕëüĠĈēÿĜňčüĢéĢüèĕüåĆýĆĐý 40 þĿāĆĘĄŇĕ ĄĘâĕĆýĆĆąĕąāėğċČĠĈēâĕĆýĆėâĕĆøĆĊéčěãăĕāĠĈēåĔ÷âĆĐè þŌîĎĕéĕââĕĆĢëňąĕğýĚĨĐèøňü  ™ čĄĕåĄĒ ğþŎüğéňĕăĕāĆŇĊĄâĔýċĜüąŋğĀŃĕĆēĊĔèåĊĕĄþĈĐ÷ăĔąéĕââĕĆĢëňÿĈėøăĔöôŋčěãăĕā čĬĕüĔâèĕüåöē âĆĆĄâĕĆĐĕĎĕĆĠĈēąĕ ĠĈēğåĆĚĐãŇĕąúĔèĨ ăĕåĆĔòĠĈēğĐâëü éĔ÷èĕüþĆēëěĄğĀŃĕĆēĊĔèåĊĕĄþĈĐ÷ăĔąéĕââĕĆĢëňÿĈėøăĔöôŋ čěãăĕāìęħèéĔ÷øŇĐğüĚħĐèğþŎüþĆēéĬĕúěâþĿ ĢĎňÿĜňčüĢéğãňĕĆŇĊĄâėéâĆĆĄ 

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• …ÍšŠ†™zš‰š}‹xš‹ÓšŠš  ™ āĔõüĕåĜŇĄĚĐâĕĆāĔõüĕøüğĐèčĜŇâĕĆĄĘĊėûĘþñėýĔøėúĘħ÷ĘúĕèğăčĔëâĆĆĄĢüĆňĕüąĕ (Self Development Manual on Good Pharmacy Practice in Community Pharmacy Settings) ĆŇĊĄâĔýčĬĕüĔâèĕüåöēâĆĆĄâĕĆĐĕĎĕĆĠĈēąĕ (Đą.) ìęħèģ÷ňĆĔýâĕĆøĐýĆĔýéĕâĎĈĕąăĕåčŇĊüğþŎüĐąŇĕè÷Ę ĠĈēâĬĕĈĔèāėéĕĆöĕĠâňģãþĆĔýþĆěèĠĈēøĘāėĄāŋĢĎĄŇğāėħĄğøėĄ  ™ čĄĕåĄĒ ğãňĕĆŇĊĄğþŎüåöēúĬĕèĕüĢüâĕĆ ĆŇĕèåĜĄŇ ĐĚ ğĀŃĕĆēĊĔèåĊĕĄþĈĐ÷ăĔąéĕââĕĆĢëňÿĈėøăĔöôŋčãě ăĕāčĬĕĎĆĔý ğăčĔëâĆĆňĕüąĕ ğāĚħĐĢëňğþŎüĠüĊúĕèþñėýĔøėĢüâĕĆĠüēüĬĕ ĢĎňãňĐĄĜĈĎĆĚĐčŇèøŇĐÿĜňþłĊąúĘħğĎĄĕēčĄøŇĐģþ  ™ čĄĕåĄĒ ģ÷ňĆĔýâĕĆčüĔýčüěüèýþĆēĄĕöġåĆèâĕĆ GPP Promotion project éĕâ FIP ĠĈēģ÷ňğëėîĊėúąĕâĆ ÿĜňğëĘħąĊëĕî (Ms.Eeva Terasalmi) éĕâþĆēğúċĂľüĠĈü÷ŋ ĄĕĠüēüĬĕĠüĊúĕèâĕĆéĔ÷úĬĕ GPP Quality Indicator ĢĎň čĕĄĕĆùþĆēąěâøŋĢëňģ÷ňâĔýýĆėýúãĐèþĆēğúċģúą • ošœršr†¥˜iœpi‹‹‰•ïª  ™ åöēâĆĆĄâĕĆãĐèčĄĕåĄĒ ğãňĕĆŇĊĄèĕüčĄĔëëĕčěãăĕāĠĎŇèëĕøė ā.ċ.2553 ğāĚħĐĆĔýúĆĕýĄøėčĄĔëëĕĢü þĆēğ÷ĦüúĘħĄĘâĕĆüĬĕğčüĐĠĈēúėċúĕèãĐèĆēýýčěãăĕāãĐèþĆēğúċ  ™ øĔĊĠúüčĄĕåĄĒ ĆŇĊĄâĔýġåĆèâĕĆāĔõüĕåěöăĕāĆňĕüąĕ čĬĕüĔâèĕüåöēâĆĆĄâĕĆĐĕĎĕĆĠĈēąĕ ĐĐâğąĘħąĄ āýþēčĄĕëėâ ğăčĔëâĆĠĈēÿĜňþĆēâĐýâĕĆĆňĕüąĕĢüéĔèĎĊĔ÷āėéėøĆ ĐěúĔąûĕüĘ âĬĕĠāèğāëĆ čěġãúĔą ĠĈēĈĬĕþĕè ĢĎňãňĐĄĜĈ åĬĕĠüēüĬĕĠĈēčüĔýčüěüĢüâĕĆāĔõüĕğãňĕčĜŇĆňĕüąĕåěöăĕā  ™ čĄĕåĄĒ ĆŇĊĄâĔýĠÿüèĕüåěňĄåĆĐèÿĜňýĆėġăå÷ňĕüčěãăĕā éěďĕĈèâĆöŋĄĎĕĊėúąĕĈĔą ĆėğĆėħĄġåĆèâĕĆüĬĕĆŇĐèğāĚħĐ éĔ÷úĬĕĠÿüúĘħĆňĕüąĕ (Google mapping) ġ÷ąğâĦýĆĊýĆĊĄòĕüãňĐĄĜĈĠĈēğÿąĠāĆŇãňĐĄĜĈĆňĕüąĕúĘħĄĘğăčĔëâĆþñėýĔøėèĕü þĆēéĬĕÿŇĕüúĕèğĊĦýģìøŋ www.ranya.org ğāĚħĐĢĎňþĆēëĕëüÿĜňčüĢéúĔħĊģþčĕĄĕĆùčĚýåňüģ÷ňġ÷ąèŇĕą

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2552 éĔ÷ãęĨüĢüĊĔüĐĕúėøąŋúĘħ 7 ĄĘüĕåĄ 2553 ö ċĜüąŋüėúĆĆċâĕĆĠĈēâĕĆ þĆēëěĄģýğúå ýĕèüĕ ġ÷ąĄĘčĄĕëėâĠĈēÿĜňčüĢéğãňĕĆŇĊĄèĕüþĆēĄĕö 400 åü ĠĈēĄĘăĕåĘğåĆĚĐãŇĕą ýĆėČĔúąĕ ĠĈē ÿĈėøăĔöôŋčěãăĕāëĔĨüüĬĕğãňĕĆŇĊĄĐĐâìěňĄĠč÷èčėüåňĕþĆēĄĕö 60 ìěňĄ ăĕąĢüèĕüéĔ÷ĢĎňĄĘâĕĆýĆĆąĕąāėğċČğâĘħąĊâĔý þĆēëĕåĄĐĕğìĘąüĠĈēĐüĕåøĆňĕüąĕĢüþĿ 2012 ĆĊĄúĔĨèâĕĆþĆēëěĄĊėëĕâĕĆéĕâ 3 ýĆėČĔúëĔĨüüĬĕ  ™ èĕüčĔþ÷ĕĎŋğăčĔëâĆĆĄþĆēéĬĕþĿ 2553 éĔ÷ãęĨüĢüĆēĎĊŇĕèĊĔüúĘħ 26 Ąėùěüĕąü ùęè 2 âĆâðĕåĄ 2553 ìęħèčăĕ ğăčĔëâĆĆĄéĔ÷ãęĨüğþŎüþĆēéĬĕúěâþĿ ğāĚħĐĢĎňþĆēëĕëüúĆĕýùęèýúýĕúãĐèğăčĔëâĆčĕãĕøŇĕèĥ éĔ÷èĕüÿŇĕüăĕåĘğåĆĚĐãŇĕą ğăčĔëâĆúĔħĊþĆēğúċ ĆĊĄúĔĨèčĄĕåĄğăčĔëâĆĆĄëěĄëüĒ ġ÷ąþĿüĘĨģ÷ňéĔ÷ĆöĆèåŋĢüĎĔĊãňĐ ĆĐýĆĜňğĆĚħĐèąĕ þĆęâČĕğăčĔë Ĉ÷ ąĕğĎĈĚĐĢëň þĈĐ÷ăĔą þĈĐ÷ġĆå  ™ čĄĕåĄĒ ëŇĊąğĎĈĚĐčĄĕëėâĠĈēþĆēëĕëüÿĜňþĆēčýăĔąüĨĬĕúŇĊĄÿŇĕü 2 ëŇĐèúĕèåĚĐ - åöēâĆĆĄâĕĆčĄĕåĄĒ ğ÷ėüúĕèāýþē ğąĘħąĄğąĘąü ĢĎňâĬĕĈĔèĢéāĆňĐĄĄĐýğèėüëŇĊąğĎĈĚĐĠâŇčĄĕëėâúĘħģ÷ňĆĔý åĊĕĄğ÷ĚĐ÷ĆňĐüĎĈĕąéĔèĎĊĔ÷ Đĕúė éĔèĎĊĔ÷üåĆĆĕëčĘĄĕĠĈēčèãĈĕ - čĄĕåĄĒ ĢüüĕĄčĄĕāĔüûŋāĔõüĕåěöăĕāĆňĕüąĕĠĎŇèþĆēğúċģúą ĄĐýğèėüĢĎňčĬĕüĔâèĕüåöēâĆĆĄâĕĆ ĐĕĎĕĆĠĈēąĕ čüĔýčüěüâĕĆéĔ÷ìĚĨĐğĊëăĔöôŋĠĈēğåĆĚħĐèĐěþġăåýĆėġăå ëŇĊąğĎĈĚĐÿĜňþĆēčýăĔąüĨĬĕúŇĊĄ  ™ åöēâĆĆĄâĕĆčĄĕåĄĒ ĆŇĊĄâėéâĆĆĄğāĚħĐčĔèåĄâĔý ýĆėČĔú ÷ĘğåğĐčğĐë þĆēğúċģúą éĬĕâĔ÷ ĆŇĊĄāĔõüĕġĆèğĆĘąü ĄĐýğèėüčüĔýčüěü ĐěþâĆöŋâĕĆğĆĘąüĠĈēğĈĘĨąèĐĕĎĕĆâĈĕèĊĔüüĔâğĆĘąüġĆèğĆĘąüĊĔ÷ĐėüúĆŋ ĐĬĕğăĐýĕèĢĎîŇ éĔèĎĊĔ÷üüúýěĆĘ  ™ čĄĕåĄĒ ĆŇĊĄâĔýčăĕğăčĔëâĆĆĄĠĈēăĕåĘğåĆĚĐãŇĕąĊėëĕëĘā éĔ÷èĕüčĄĔëëĕğăčĔëâĆĆĄģúą 97 þĿ “åĊĕĄĆĔý ÿė÷ëĐýãĐèğăčĔëâĆģúą ĢüâĕĆþñėýĔøėèĕüĢüĆňĕüąĕ” ĢüĊĔüúĘħ 8 ûĔüĊĕåĄ 2553 ìęħèğþŎüčŇĊüĎüęħèãĐèâĕĆğøĆĘąĄâĕĆ čĄĔëëĕğăčĔëâĆĆĄģúą 100 þĿ (ā.ċ.2556) ġ÷ąĢüèĕüĄĘâĕĆøė÷øĕĄĆĕąèĕüåĊĕĄâňĕĊĎüňĕãĐèĠøŇĈēčĕãĕãĐèĊėëĕëĘā éĕâĄøėčĄĔëëĕþĿúĘħÿŇĕüĄĕ üĬĕğčüĐþĆēğ÷ĦüčĄĔëëĕĠĈēğþľ÷ĆĔýĂŌèåĊĕĄåė÷ğĎĦüøŇĐâĕĆāĔõüĕĊėëĕëĘāğăčĔëâĆĆĄ čĕãĕ ğăčĔëâĆĆĄëěĄëü 

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1.1 âĕĆĠùĈèÿĈèĕüčĄĕåĄĒ þĿ 2552 ăî.ëňĐèĄĕċ üėøėċćèåĕĆėü ğĈãĕûėâĕĆčĄĕåĄĒ ĠùĈèÿĈèĕüčĄĕåĄğăčĔëâĆĆĄëěĄëü (þĆēğúċģúą) ĢüĆĐý þĿ 2552 úĘħÿŇĕüĄĕġ÷ąĠýŇèøĕĄĀłĕąøŇĕèĥ ÷ĔèüĘĨ ĀłĕąčĄĕëėâ čĄĕåĄĒ ĄĘčĄĕëėâ ö þŌééěýĔü 3,088 úŇĕü čĄĔåĆĢĎĄŇ 243 åü åė÷ğþŎü 8% ÷ĔèüĔĨüúĕèčĄĕåĄĒ éęèĄĘčĄĕëėâğāėħĄ ãęĨüúěâþĿ ìęħèčĄĕëėâčŇĊüĢĎîŇğþŎüÿĜňĄĘĎüňĕúĘħþñėýĔøėâĕĆĢüĆňĕüąĕ ğāĚħĐåĊĕĄğãňĄĠãĦèĢüĊėëĕëĘā ĀłĕąĊėëĕâĕĆ čĄĕåĄĒ ĄĘâĕĆéĔ÷þĆēëěĄĊėëĕâĕĆþĆēéĬĕğ÷ĚĐüúĔĨèčėĨü 13 åĆĔĨè þĆēëěĄğëėèþñėýĔøėâĕĆ 1 åĆĔĨè þĆēëěĄĢĎîŇčĕĄĔî þĆēéĬĕþĿ 1 åĆĔĨè ìęħèúĕèčĄĕåĄĒ éēāąĕąĕĄéĔ÷ĢĎňĄĘâĕĆþĆēëěĄğëėèþñėýĔøėâĕĆĠĈēĄĘâĕĆúĬĕ Workshop âĕĆğëĚħĐĄøŇĐ âĕĆ Refill ąĕ âĕĆĢëňĢýčĔħèąĕ øňĐèĄĘâĕĆĐýĆĄĠĈēğĆĘąüĆĜňčėħèğĎĈŇĕüĘĨğāėħĄãęĨü ĀłĕąāĔõüĕåěöăĕāĆňĕüąĕ čĄĕåĄğăčĔëâĆĆĄëěĄëüğþŎüăĕåĘãĐèĐèåŋâĆĊėëĕëĘāĆŇĊĄâĔýčĄĕāĔüûŋāĔõüĕåěöăĕāĆňĕüąĕĠĎŇèþĆēğúċģúąĄĘ âĕĆþĆēčĕü ğāĚħĐąâĆē÷ĔýåěöăĕāĆňĕüąĕúĔĨèĎĄ÷úĔĨèúĘħğéňĕãĐèğþŎüğăčĔëâĆ ĠĈēģĄŇģ÷ňğþŎüğăčĔëâĆģ÷ňĆŇĊĄâĔýčĄĕāĔüûŋ āĔõüĕåěöăĕāĆňĕüąĕĠĎŇèþĆēğúċģúą éĔ÷þĆēëěĄ 3 åĆĔĨè ğāĚħĐčĆňĕè role model ĢĎňğãňĕĢéëĔ÷ğéüĢüğĆĚħĐèâĕĆþñėýĔøė ëĔ÷ğéüĢüğĆĚħĐèãĐèéĆĆąĕýĆĆö ğÿąĠāĆŇčėħèúĘħğþŎüþĆēġąëüŋ čĄĕëėâčĕĄĕĆùğãňĕģþ÷ĜĆĕąĈēğĐĘą÷ģ÷ňĢü Website ĠĈē ĊĕĆčĕĆãĐèčĄĕåĄĒ ĠĈēéĔ÷ĢĎňĄĘâĕĆĐýĆĄüėčėøüĔâċęâČĕğăčĔëċĕčøĆŋâŇĐüğĆėħĄâĕĆþñėýĔøėâĕĆĢüĆňĕüąĕ ĢĎňğãňĕĢéâð ğâöôŋ âðĆēğýĘąýĄĕâãęĨü

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ĀłĕąþĆēëĕčĔĄāĔüûŋ čĄĕëėâčĕĄĕĆù÷ĜãňĐĄĜĈģ÷ňéĕâ Website ãĐèčĄĕåĄĒ www.pharcpa.com ìęħèĄĘâĕĆğÿąĠāĆŇãňĐĄĜĈúĕè÷ňĕü ĊėëĕëĘāãĐèğăčĔëâĆĆĄëěĄëü ĢüâĕĆğþŎüĊėúąĕâĆğÿąĠāĆŇåĊĕĄĆĜňúĕèčùĕüĘĊėúąě AM.1143, FM.89.5 ĠĈēğåğýėĈúĘĊĘ (P5TV) ĄĘâĕĆéĔ÷èĕüčĔþ÷ĕĎŋğăčĔëâĆĆĄĆŇĊĄâĔýčăĕğăčĔëâĆĆĄĠĈēĐèåŋâĆøŇĕèĥ ĢüğĆĚħĐèãĐèĊėëĕëĘā ġ÷ąþĿüĘĨčăĕĒ ğþŎü ğéňĕăĕāĢüâĕĆéĔ÷ğĆĚħĐèğāĚħĐĢĎňøŇĐğüĚħĐèĠĈēĢĎňþĆēëĕëüğãňĕĢéýúýĕúãĐèğăčĔëâĆĄĕâãęĨü ĀłĕąāĔõüĕýúýĕúĆňĕüąĕ čĄĕåĄĒ ģ÷ňāąĕąĕĄĢĎňĄĘâĕĆāĔõüĕčĄĕëėâğāĚħĐğøĆĘąĄāĆňĐĄĆĔýâĕĆğãňĕĆŇĊĄĆēýýĎĈĔâþĆēâĔüčěãăĕāĄĕâãęĨü ĄĘ âĕĆÿĈĔâ÷ĔüġåĆèâĕĆøŇĕèĥ ÷ĔèüĘĨ 1. ĆŇĊĄâĔýĆňĕüąĕğåĆĚĐãŇĕąãĐè âúĄ. ĄĘâĕĆĠéâúĆĕąĐēğýúĠĈēâĕĆåĔ÷âĆĐèġĆåøė÷øŇĐ ġĆåĆēýĕ÷øŇĕèĥ ĠĈňĊ čŇèøŇĐÿĜňþłĊąģþąĔèčĬĕüĔâĐüĕĄĔąĢâĈňýňĕü 2. ġåĆèâĕĆğąĘħąĄýňĕü ìęħèĢüþĿúĘħĠĈňĊģ÷ňþĆēčýåĊĕĄčĬĕğĆĦé ġ÷ąčĕĄĕĆùğąĘħąĄģ÷ň 800 Ćĕą ìęħèĆňĕüąĕĢ÷čüĢé čĄĔåĆğãňĕĆŇĊĄġåĆèâĕĆğăčĔëâĆëěĄëüğąĘħąĄýňĕüģ÷ň čĕĄĕĆùčĄĔåĆğãňĕĆŇĊĄġåĆèâĕĆģ÷ňúĘħ Board ĎüňĕĎňĐèþĆēëěĄ 3. čĄĕåĄĒ ģ÷ňĆŇĊĄâĔý ýĆėČĔú ĂĕĆŋĄĕìĘğüúğĊĐĆŋå ĠĈēýĆėČĔú ĐąěûąĕìĘāĘĐĔĈģĈĠĐüìŋ ĢüġåĆèâĕĆåĚüâĬĕģĆÿĜňìĚĨĐ þĆēâĔüëĘĊėø 4. čĄĕåĄĒ ģ÷ňĆŇĊĄâĔý ĄĜĈüėûė PSI ġ÷ąĆĔýúěüéĕâ WORLD FUND ìęħèğþŎüâĐèúěüúĘħčüĔýčüěüğāĚħĐĈ÷âĕĆĠāĆŇ Ćēýĕ÷ãĐèğëĚĨĐğĐ÷čŋ ĀłĕąāĔõüĕĄĕøĆòĕüĆňĕüąĕ øĕĄúĘħ ăâ.čĄýĔøė ĠâňĊéėü÷ĕ ģ÷ňĠéňèģþĠĈňĊĊŇĕ ãöēüĘĨĄĘâĕĆĆŇĕèåĜŇĄĚĐâĕĆāĔõüĕøüğĐèĢĎňĄĘâĕĆþñėýĔøėúĘħ÷ĘĢü Ćňĕüąĕ čĄĕåĄĒ ģ÷ňéĔ÷āėĄāŋåĜŇĄĚĐüĘĨģĊňéĬĕĎüŇĕąĢĎňâĔýčĄĕëėâ ğĆĦĊĥ üĘĨ ğāĚħĐĢëňğþŎüåĜŇĄĚĐĢüâĕĆāĔõüĕĆňĕüąĕãĐèčĄĕëėâ  čĄĕåĄĒ ģ÷ňĆŇĊĄĄĚĐâĔý Đą. ĢüâĕĆĆŇĕèâðâĆēúĆĊè øĕĄúĘħ ăâ.ĊĆĕĊěûģ÷ňĠéňèģĊňĠĈňĊ  čĄĕåĄĒ ģ÷ňĄĘâĕĆĆŇĊĄĆŇĕèãňĐýĔèåĔýčăĕğăčĔëâĆĆĄ  ĆŇĊĄğþŎüğåĆĚĐãŇĕąčĄĔëëĕčěãăĕā  ĆŇĊĄğþŎüăĕåĘğåĆĚĐãŇĕąğĐâëüĢü÷ňĕüčěãăĕā ĠĈēèĕüþĆēëěĄčĄĔëëĕčěãăĕāĠĎŇèëĕøė  ĄĘâĕĆéĔ÷úĬĕĠüĊþñėýĔøėâĕĆĢëňąĕþñėëĘĊüēĢüĆňĕüąĕ úĔĨèĎĄ÷üĘĨğþŎüâĕĆğÿąĠāĆŇĊėëĕëĘāğăčĔëâĆĆĄëěĄëüĢĎňğþŎüúĘħĆĜňéĔâ ğþŎüúĘħąĐĄĆĔýãĐèþĆēëĕëüĢĎňģ÷ň ĠĈēĢüþĿüĘĨğĐè čĄĕåĄğăčĔëâĆĆĄëěĄëüģ÷ňĆĔýĆĕèĊĔĈğþŎüġĈŇþĆēâĕċğâĘąĆøėåěöĊŇĕğþŎüĐèåŋâĆÿĜňčüĔýčüěüĢüġåĆèâĕĆøŇĕèĥ ãĐè Đą. Ģü èĕüåĆýĆĐý 35 þĿãĐè Đą. ãĐĢĎňčĄĕëėâúěâåüëŇĊąâĔüāĔõüĕĆňĕüąĕĢĎňğþŎüúĘħąĐĄĆĔýãĐèþĆēëĕëüĢĎňģ÷ň 1.2 úėċúĕèâĕĆ÷ĬĕğüėüèĕüãĐèčĄĕåĄĒ þĿ 2553 ăî.ëňĐèĄĕċ üėøėċćèåĕĆėü ğĈãĕûėâĕĆčĄĕåĄĒ âĈŇĕĊùęèúėċúĕèâĕĆ÷ĬĕğüėüèĕüãĐèčĄĕåĄĒ ĢüþĿ 2553 ÷ĔèüĘĨ éēčüĐèüġąýĕąãĐèâĆēúĆĊèčĕûĕĆöčěã ÿĈĔâ÷ĔüĢĎňĄĘâĕĆğëĚħĐĄøŇĐâĔýĆēýýĎĈĔâþĆēâĔüčěãăĕā ĢĎňĄĘĆňĕü ąĕúĘħĄĘğăčĔëâĆþñėýĔøėĎüňĕúĘħøĈĐ÷ğĊĈĕúĘħğþľ÷úĬĕâĕĆ ğāėħĄčĄĆĆùüēĢüâĕĆĢëňğúåġüġĈąĘĢüâĕĆþñėýĔøėâĕĆãĐèğăčĔëâĆëěĄëü ĠĈēéēĄĘâĕĆĐýĆĄğāėħĄãęĨüĢüþĿüĘĨ

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š‹˜¬ 2 ¤‹ï•o‹™‚‹•o‹šŠošiš‹ƒ‹˜r ‰§“uҒš‰™uƒ‹˜p±šƒÊ 2551 ¤‰ï•™¬ 7 ‰šl‰ 2552 ĄøėúĘħþĆēëěĄ úĘħþĆēëěĄĆĔýĆĐèĆĕąèĕüâĕĆþĆēëěĄĢĎîŇčĕĄĔîþĆēéĬĕþĿ 2551 ğĄĚħĐĊĔüúĘħ 7 ĄĘüĕåĄ 2552

š‹˜¬ 3 ¤‹ï•o‹šŠoš¥˜‹™‚‹•oo‚iš‹¤oœj•o’‰šl‰—

ăî.üăĕāĆ ğčùĘąĆûĆĆĄâěĈ ğĎĆĔîîėâčĄĕåĄĒ âĈŇĕĊĆĕąèĕüâĕĆğèėüãĐèčĄĕåĄĒ ĢüþĿ 2552 ÷ĔèüĘĨ ĢüþĿ 2552 čĄĕåĄĒ ĄĘĆĕąģ÷ňéĕâèýğąĘħąĄýňĕüéĕâ čþčë. Ąĕ 2 Ĉňĕüýĕú ĆĕąĆĔýãĐèčĄĕåĄĒ čŇĊüĢĎîŇĄĕéĕâ âĕĆčĄĔåĆčĄĕëėâĠĈēğèėüýĆėéĕå čŇĊüĆĕąéŇĕąĎĈĔââĦğþŎüğèėüğ÷ĚĐüĠĈēğýĘĨąğĈĘĨąè þĿüĘĨčĄĕåĄĒ ĄĘĆĕąĆĔý 7,328,297.80 ýĕú (Ďüňĕ 27) ĆĕąéŇĕą 3,821,........ ýĕú ìęħèĄĘĆĕąĆĔýĄĕââĊŇĕĆĕąéŇĕą 3,430,.......... ýĕú üĐâéĕâüĘĨčĄĕåĄĒ ąĔèģ÷ňé÷úēğýĘąüăĕČĘĄĜĈåŇĕğāėħĄģþğĄĚħĐĊĔüúĘħ 9 ĄĘüĕåĄ 2553 ìęħèčĄĕëėâúŇĕüĢ÷čüĢéìĚĨĐ čėüåňĕãĐèčĄĕåĄĒ ĢĎňĆĘýìĚĨĐģ÷ňğĈą ğāĆĕēøŇĐģþøňĐèĄĘâĕĆĐĐâĢýğčĆĦé ìęħèéēøňĐèĆĊĄ Vat ĐĘâ 7% üč.éėøĆĕüĔüúŋ ãĐğčüĐÿĜňčĐýýĔîëĘåüğ÷ėĄåĚĐ üĕąğčüĘąŋ ġčăėøĈĕăûüĕ ĎĄĕąğĈãÿĜňčĐýýĔîëĘ 4043 ĠĈēãĐâĕĆ ĆĔýĆĐèéĕâúĘħþĆēëěĄĢĎňğþŎüÿĜňčĐýýĔîëĘãĐèčĄĕåĄĒ ĄøėúĘħþĆēëěĄ úĘħþĆēëěĄĆĔýĆĐèèýâĕĆğèėüãĐèčĄĕåĄĒ ĠĈēĢĎňüĕąğčüĘąŋ ġčăėøĈĕăûüĕ ğþŎüÿĜňčĐýýĔîëĘãĐèčĄĕåĄĒ ĢüþĿ 2553 øŇĐģþ

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’ˆš¤ˆ’™ri‹‹‰¤•šp‹œo¤‹ï•oƒØu“š¥jƒÎšŠ †™i§rÓ§‚• uš}•ŠÒšoÓ•Š 1 ƒÊ čăĕğăčĔëâĆĆĄĄĘĄøėëĔ÷ğéü âĆöĘúĘħĄĘâĕĆĆňĐèğĆĘąüéĆĆąĕýĆĆöãĐèğăčĔëâĆúŇĕüĢ÷ĢüğĆĚħĐèâĕĆĠãĊüþŃĕą ĎĆĚĐâĕĆ ģĄŇģþþñėýĔøėĎüňĕúĘħĢüĆňĕüąĕøĕĄúĘħâðĎĄĕąâĬĕĎü÷ ĢüĆēąēøŇĐģþ ĎĕâÿĈâĕĆčĐýčĊüāýĊŇĕ ĄĘĄĜĈåĊĕĄÿė÷ øŇĐģþčăĕ ğăčĔëâĆĆĄéēāėéĕĆöĕğāėħĄâĕĆĈèġúČãĔĨüøħĬĕğþŎüāĔâĢëňĢýĐüěîĕøĐąŇĕèüňĐą 1 þĿ øĕĄĈĔâČöēĠĈēğéøüĕãĐèâĕĆâĆēúĬĕ ÿė÷ éĕâğ÷ėĄúĘħğåąāĔâĢëňĢýĐüěîĕø ğāĘąè 3 ğ÷ĚĐü ġ÷ąåĕ÷ĊŇĕéēëŇĊąþŃĐèþĆĕĄþŌîĎĕğăčĔëâĆĠãĊüþŃĕąĈèģ÷ňýňĕè ğüĚħĐèéĕâ ĎĈĔèéĕâúĘħčăĕğăčĔëâĆĆĄģ÷ňĄĘâĕĆāėéĕĆöĕĈèġúČğăčĔëâĆĠãĊüþŃĕąģþâĊŇĕ 400 åüĢüĆēąēğĊĈĕ 3 þĿúĘħÿŇĕüĄĕĠøŇþŌîĎĕ ğăčĔëâĆĠãĊüþŃĕąâĦąĔèģĄŇĄĘúĘúŇĕĊŇĕéēĈ÷Ĉè ìęħèĢüþĿ 2554 üĘĨčĬĕüĔâèĕüåöēâĆĆĄâĕĆĐĕĎĕĆĠĈēąĕâĦĄĘüġąýĕąúĘħéēčŇèčĕĆĊĔøĆąĕģþøĆĊéâĕĆğþŎüÿĜňĄĘĎüňĕúĘħ þñėýĔøėâĕĆãĐèğăčĔëâĆĆňĕüąĕ÷ňĊą ĠĈēčăĕğăčĔëâĆĆĄğĐèâĦģ÷ňāėéĕĆöĕĠĈēĐüěĄĔøė ġåĆèâĕĆĆöĆèåŋğĀŃĕĆēĊĔèĠĈēčŇèğčĆėĄ éĆĆąĕýĆĆöâĕĆğþŎüÿĜňĄĘĎüňĕúĘħþñėýĔøėâĕĆĢüĆňĕüąĕğëėèĆěâ ĢüâĕĆþĆēëěĄâĆĆĄâĕĆčăĕğăčĔëâĆĆĄåĆĔĨèúĘħ 185 (9/2553) ğĄĚħĐ ĊĔüúĘħ 20 âĔüąĕąü 2553 ġ÷ąéēĄĘĄĕøĆâĕĆğëėèĆěâğāĚħĐĠâňģãþŌîĎĕğăčĔëâĆĠãĊüþŃĕąúĔĨèĆēýýüĐâéĕââĕĆğāėħĄâĕĆĈèġúČ āĔâĢëňĢýĐüěîĕøğăčĔëâĆĠãĊüþŃĕąãĔĨüøħĬĕğþŎüĆēąēğĊĈĕ 1 þĿ ġ÷ąĄĘĄĕøĆâĕĆğëėèĆěâúĘħčĬĕåĔîåĊýåĜŇģþ Đĕúė 1) ĆöĆèåŋčĆňĕèåĊĕĄğãňĕĢéâĔýčĄĕëėâĢüâĕĆğþŎüÿĜňĄĘĎüňĕúĘħþñėýĔøėâĕĆĢüĆňĕüąĕúĘħ÷Ę 2) čĆňĕèåĊĕĄøĆēĎüĔâĢüğĆĚħĐèâĕĆþĆēâĐýĊėëĕëĘāĢüĆňĕüąĕĠâŇüĔâċęâČĕ 3) âĕĆğãňĄèĊ÷ĢüâĕĆĈèġúČğăčĔëâĆúĘħþĆēāćøėÿė÷éĆĆąĕýĆĆöĢüĆňĕüąĕ 4) āĔõüĕĆēýýĠĈēğåĆĚĐãŇĕąâĕĆğĀŃĕĆēĊĔèâĕĆğþŎüÿĜňĄĘĎüňĕúĘħþñėýĔøėâĕĆĢüĆňĕüąĕ 5) âĕĆâĬĕâĔý÷ĜĠĈâĕĆþñėýĔøėãĐèÿĜňĄĘĎüňĕúĘħþñėýĔøėâĕĆĢüĆňĕüąĕğëėèĆěâ ġ÷ąâĕĆčěŇĄøĆĊéčĐýøĔĊğăčĔëâĆÿĜňĄĘĎüňĕúĘħ þñėýĔøėâĕĆ ġ÷ąāüĔâèĕüğéňĕĎüňĕúĘħãĐèčăĕğăčĔëâĆĆĄğĐè 6) âĕĆąâąŇĐèëĄğëąĆňĕüąĕúĘħþñėýĔøėøüğþŎüøĔĊĐąŇĕèúĘħ÷ĘĠĈēčĆňĕèþĆēġąëüŋøŇĐčĔèåĄĠĈēëěĄëü ġ÷ąčăĕğăčĔëâĆĆĄéēĄĘâĕĆ÷ĬĕğüėüâĕĆøŇĐğüĚħĐè øĔĨèĠøŇþĿ 2554 üĘĨ ğþŎüøňüģþ ġ÷ąğêāĕēĐąŇĕèąėħèéēğĆėħĄâĕĆĆöĆèåŋ ğāĚħĐĢĎňĄĘĎüŇĊąèĕüĎĆĚĐéĔèĎĊĔ÷þĈĐ÷âĕĆĠãĊüþŃĕą 100% (ĎĄĕąùęè ğăčĔëâĆĢüĎüŇĊąèĕüģĄŇĄĘĢåĆĠãĊüþŃĕą ĎĆĚĐĎĕâĄĘ ğăčĔëâĆĢüĎüŇĊąèĕüúŇĕüĢ÷ģþåěĄĆňĕüąĕ âĦøňĐèģþþñėýĔøėĎüňĕúĘħøĕĄúĘħâðĎĄĕąâĬĕĎü÷ ĎĆĚĐğþľ÷ğêāĕēğĊĈĕúĘħğăčĔëâĆĊŇĕè éĕââĕĆúĬĕèĕüþâøėĠĈňĊ) ĠĈēčăĕğăčĔëâĆĆĄéēģ÷ňĄĘâĕĆéĔ÷āėûĘĄĐýġĈŇþĆēâĕċğâĘąĆøėåěöĠâŇĎüŇĊąèĕüĎĆĚĐéĔèĎĊĔ÷úĘħþĈĐ÷ âĕĆĠãĊüþŃĕą 100% ĢüëŇĊèèĕüčĔþ÷ĕĎŋğăčĔëâĆĆĄ þĿ 2554 üĘĨøŇĐģþ éęèãĐğëėîëĊüĎüŇĊąèĕü éĔèĎĊĔ÷øŇĕèĥ ĠĈēĐèåŋâĆĊėëĕëĘā ĆŇĊĄĆöĆèåŋĠĈēčĄĔåĆğãňĕĆŇĊĄġåĆèâĕĆ ĎüŇĊąèĕüĎĆĚĐ éĔèĎĊĔ÷þĈĐ÷âĕĆĠãĊüþŃĕą 100% ÷ňĊą Ćċ.(āėğċČ) ăâ.âėøøė āėúĔâČŋüėøėüĔüúŋ ĐěþüĕąâčăĕğăčĔëâĆĆĄ åüúĘħĎüęħè úĘħĄĕ: http://www.facebook.com/l/46d0fG6Ar4DI5BwqbWvR0tPvP3A;www.pharmacafe.com/board/viewtopic.php?f= 1&t=32647&start=165 ĊĕĆčĕĆčăĕğăčĔëâĆĆĄþĿúĘħ 14 êýĔýúĘħ 4 øěĈĕåĄ – ûĔüĊĕåĄ 2553

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Қ’‰šrœi’‰šl‰— ¬‹™i iҚl‹™‚ âŇĐüéēĎĄ÷ĊĕĆēĠĎŇèâĕĆğþŎüÿĜňüĬĕĐèåŋâĕĆĠĎŇèüĘĨ úĕèýĆĆöĕûėâĕĆģ÷ňãĐ ĢĎňÿĄğãĘąüýúåĊĕĄüĘãĨ üĨę ğāĚĐħ ùŇĕąúĐ÷ĠüĊåė÷ĠĈēåĊĕĄĆĜčň âę ĢüâĕĆúĬĕèĕüĢĎňúĕŇ üģ÷ňĐĕŇ üâĔü øňĐèąĐĄĆĔýåĆĔýĊŇĕÿĄĄĘåĊĕĄ ÿĜâāĔüâĔýĐèåŋâĕĆĠĎŇèüĘğĨ þŎüĐąŇĕèĄĕâğþŎüğĊĈĕąĕĊüĕüøĔèĨ ĠøŇčýė þĿúĠħĘ ĈňĊ ğþŎüâĆĆĄâĕĆčĄĕåĄĒ ĢüøĬĕĠĎüŇèĐěþüĕąâĒ ùęèčĕĄčĄĔą âŇĐüéēğþŎüüĕąâčĄĕåĄĒ ĐĘâčĐèčĄĔąéüùęèýĔ÷üĘĨ ÿĄġëå÷ĘúģħĘ ÷ňúĕĬ èĕüĆŇĊĄâĔýâĆĆĄâĕĆčĄĕåĄĒ āĘĥħ üňĐèĥ ÿĜňĄĘåĊĕĄøĔĨèĢé ĄĘåĊĕĄğčĘąčĈēúěâåü âĆĆĄâĕĆčĄĕåĄĒ ĢüĠøŇĈēčĄĔąøňĐèāąĕąĕĄëĔâëĊüâĔüĐąŇĕèĄĕâúĘğ÷ĘąĊğāĚħĐĢĎň ĄĕčĄĔåĆğþŎüâĆĆĄâĕĆğāĆĕēúěâúŇĕüâĦúĆĕý÷ĘĠâŇĢéĠĈňĊĊŇĕ âĕĆğþŎüâĆĆĄâĕĆčĄĕåĄĒ éēøňĐèþŌüğĊĈĕãĐèøüúĘħĄĘĐąĜŇìęħè ĄĘģĄŇĄĕâüĔüĨ ĄĕúĬĕèĕüġ÷ąģĄŇĎĊĔèÿĈøĐýĠúüùęèĠĄňéēĄĘåĕŇ ĢëňéĕŇ ąúĔèĨ åŇĕğ÷ėüúĕè åŇĕğĊĈĕ ĠĈēąĔèĄĘåĕŇ éňĕèúĘéħ ēøňĐèĢëňĢü âĕĆéňĕèğăčĔëâĆĄĕĐąĜŇĠúüøüğĄĚħĐĄĘăĕĆâėéčĬĕåĔîúĘħøüøňĐèĆĔýÿė÷ëĐý ýĕèåĆĔĨèâĦøňĐèþľ÷ĆňĕüğāĚħĐģþĆŇĊĄăĕĆâėéğĎĈŇĕüĔĨü čĬĕĎĆĔýÿĄğĐèĠĈēğāĚħĐüâĆĆĄâĕĆĐĘâĎĈĕąåüâĦåèĄĘþĆēčýâĕĆöŋĈĔâČöēğ÷ĘąĊâĔüåĚĐùĜâĈĜâåňĕýŇü÷ňĊąåĊĕĄÿė÷ĎĊĔèĊŇĕ øĔĨèĢéĄĕĎĕúĘħĆňĕüĠøŇâĦģĄŇāýĐąĜŇğčĄĐĥ ģĄŇğþŎüģĆğāĆĕēğĆĕĄĘğéøüĕĆĄöŋúĘħĠüŇĊĠüŇĠĈňĊøňĐèąĚüĎąĔ÷ĠĈēĎüĔâĠüŇü üĘħğþŎü åĕùĕúĘħāĊâğĆĕĢëňâĔüğčĄĐ ğĊĈĕúĘħģ÷ňĆĔýÿĈâĆēúýüĘĨ čĬĕĎĆĔýÿĄâĦéēĢëňĊėûĘãĐġúČúĕèġúĆċĔāúŋìęħèëŇĊąģ÷ňĄĕâĠĈēâĕĆéĔ÷ úĬĕòĕüãňĐĄĜĈĈĜâåňĕåüčĬĕåĔîøĕĄ Pareto principle åĚĐ 20;80 ĎĄĕąùęèĈĜâåňĕčĬĕåĔî 20% ĠøŇĢĎňąĐ÷ãĕąùęè 80% üĐâéĕâüĘĨâĕĆéĔ÷úĬĕòĕüãňĐĄĜĈąĔèĄĘåĊĕĄčĬĕåĔîøŇĐâĕĆøė÷øĕĄâĕĆĢëňąĕĠĈēčĆňĕèĈĜâåňĕþĆēéĬĕĆĕąĢĎĄŇĥ ĠĈēĆĔâČĕ åĊĕĄčĔĄāĔüûŋĢĎňøŇĐğüĚħĐèĠĄňýĕèåĆĔĨèğĆĕģĄŇĐąĜŇúĘħĆňĕü ģĄŇģ÷ňāýþēĈĜâåňĕ÷ňĊąøüğĐèâĦøĕĄ

“™i§iš‹±šoš âĕĆúĬĕèĕüãĐèÿĄģ÷ňüĬĕĎĈĔââĕĆĠĈēĠüĊúĕèĢüâĕĆúĬĕèĕüĄĕéĕâ úŇĕüĐ÷ĘøüĕąâĒ úĔèĨ čĐèúŇĕüåĚĐāĘåħ úĕ ýĔöôėøĕüěâĈĜ ĠĈēāĘĊħ čė úě ûėī čěĆąė ĕăėĊõ Ĕ üŋ ìęħèğþŎüøňüĠýýâĕĆúĬĕèĕüãĐèāĊâğĆĕúĘħčĬĕåĔîğāĆĕēâŇĐüøĔ÷čėüĢéúĬĕĐēģĆ ġ÷ąğêāĕēğĆĚħĐèĢĎîŇĥ ĠĈňĊøňĐèĎĕĆĚĐâĆĆĄâĕĆúŇĕüĐĚħüĠĈēÿĜňğâĘħąĊãňĐè÷ĜâŇĐü ğčĄĐġ÷ąĢĎňåĕ÷âĕĆöŋùèę ÿĈâĆēúýøŇĕèĥ úĘĐħ ĕéğâė÷ãęĨüģ÷ňúĔĨèýĊâĠĈēĈýĢü ĆēąēčĔüĨ ĠĈēąĕĊ ĎĈĔâĢüâĕĆúĬĕèĕüøňĐèģĄŇğâĦýèĕüģĊňúøħĘ ĊĔ ğĐè éēøňĐèâĆēéĕą èĕüĠĈēĎĕÿĜňĆĔýÿė÷ëĐýĢüĠøŇĈēğĆĚħĐè ÿĜňüĬĕúĬĕĎüňĕúĘħĢüâĕĆĢĎňåĬĕþĆęâČĕ âĬĕâĔýĠĈēøė÷øĕĄÿĈ ÷ňĊąğĎøěüĘĨğĐèèĕüãĐèčĄĕåĄĒ éęèĄĕéĕâÿĈèĕüãĐè 29


âĆĆĄâĕĆčĄĕåĄĒ úěâåüĆŇĊĄâĔüìęħèğþŎüþŌééĔąčĜŇåĊĕĄčĬĕğĆĦéãĐèġåĆèâĕĆ øŇĕèĥ úĘħčĄĕåĄĒ úĬĕĄĕġ÷ąøĈĐ÷úěâĥ čĄĔąüĘĨ åĚĐĎĈĔââĕĆĢüâĕĆĄĐý ĎĄĕąèĕüĠýý Delegation ğþŎüâĕĆĄĐýĎĄĕąèĕüĠýýğýĦ÷ğčĆĦéĎĄĕą ùęèÿĜňĆĔýĄĐýĄĘĐĬĕüĕéĢüâĕĆøĔ÷čėüĢéĢüèĕüúĘħģ÷ňĆĔýĄĐýüĔĨüĥ èĕüúěâèĕü ĈňĊüĄĘåĊĕĄčĬĕåĔîúĔĨèčėĨüģĄŇĊŇĕéēğþŎüèĕüğĈĦâĎĆĚĐĢĎîŇ ğāĆĕēâĕĆúĘħéē úĬĕèĕüĢĎîŇĢĎňčĬĕğĆĦéģ÷ňèĕüğĈĦâĥ øňĐèþĆēčýåĊĕĄčĬĕğĆĦéâŇĐüģĄŇĊŇĕéē ğþŎüèĕüĢüčĬĕüĔâèĕüìęèħ ùĚĐğþŎüĎĔĊĢéãĐèčĄĕåĄĒ èĕüþĆēëĕčĔĄāĔüûŋ èĕü ĊėëĕâĕĆ èĕüāĔõüĕĊėëĕëĘā èĕüğëĚħĐĄøŇĐĆēýýčěãăĕā èĕüĎĕĆĕąģ÷ň èĕüâĕĆğèėü ğþŎüøňü ĎĈĔâĢüâĕĆúĬĕèĕüãĐèčĄĕåĄĒ ğĆĕąę÷ĊėčĔąúĔċüŋĠĈēğþŃĕĎĄĕąğþŎüčĬĕåĔî÷ěéğãĦĄúėċüĬĕúĕèġ÷ąĄĘąěúûċĕčøĆŋ (How?) ğþŎüĠüĊúĕèčĬĕåĔîĢüâĕĆâňĕĊğ÷ėüģþčĜŇğþŃĕĎĄĕąúĔĨèĆēąēčĔĨü âĈĕèĠĈēąĕĊ (Where we want to go?) ĠøŇúĘħ čĬĕåĔîâĊŇĕüĔĨüåĚĐâĕĆĢëňąěúûċĕčøĆŋčĜŇâĕĆþñėýĔøė (Implementation=How to?) ĢüĈĔâČöēãĐèġåĆèâĕĆøŇĕèĥ ĐĘâ ĄĕâĄĕąìęħèéēýĆĆéěĐąĜŇĢüĠÿüþñėýĔøėâĕĆ (Action Plan) ìęħèéēğþŎüĠÿüĠĄŇýú (Master Plan) øĕĄĊėčĔąúĔċüŋĠĈēğþŃĕ ĎĄĕąãĐèčĄĕåĄĒ ãĔüĨ øĐüúĘąħ ĕâúĘčħ ÷ě åĚĐâĕĆ÷ĬĕğüėüâĕĆøĕĄğþŃĕĎĄĕąĢüġåĆèâĕĆøŇĕèĥ ĐąŇĕèğþŎüĆĜþûĆĆĄìęèħ øňĐèĐĕċĔą þŌééĔąčĬĕåĔîúĘħčě÷åĚĐÿĜňåĊýåěĄġåĆèâĕĆĎĆĚĐ Project manager ğāĆĕēøňĐèúĬĕèĕüĐąŇĕèĎüĔâĢüâĕĆâĬĕĎü÷Ġÿü ÷Ĭĕğüėü èĕüøĕĄĠÿü åĊýåěĄĠÿü þĆĔýĠÿü èýþĆēĄĕöúĘħĢëň ÿĈúĘħģ÷ňĆĔý ìęħèøĆèüĘĨâĆĆĄâĕĆčŇĊüĢĎîŇĄėĐĕéúĬĕøĕĄĈĬĕāĔèģ÷ň éĬĕğþŎüøňĐèĄĘúĘĄèĕü ğþŎüåöēĐüěâĆĆĄâĕĆġåĆèâĕĆĒ ġ÷ąĄĘčĬĕüĔâèĕüğĈãĕĒ ğþŎüÿĜňþĆēčĕüèĕü

iš‹±šoš¤ƒÚ‰ ğüĚĐħ èéĕââĕĆúĬĕèĕüãĐèåöēâĆĆĄâĕĆğþŎüĐĕčĕčĄĔåĆ ÷ĔèüĔüĨ âĕĆúĘéħ ēúĬĕèĕüĢĎňčĄĔ ćúûėÿī ĈøňĐèâĕĆåĊĕĄĆŇĊĄĄĚĐ ĄĕââĊŇĕâĕĆúĬĕèĕüãĐèĎüŇĊąèĕüúĕèûěĆâėéĐĚħüĥ âĕĆúĬĕèĕüğþŎüúĘĄéęèğþŎüčėħèčĬĕåĔîĄĕâ ìęħèĎĔĊĢéãĐèâĕĆúĬĕèĕüğþŎü úĘĄúĘħ÷Ęģ÷ňĠâŇ 1. ýĆĆąĕâĕċăĕąĢüâĈěŇĄåĊĆĐýĐěŇüĠĈēğþŎüĄėøĆøŇĐâĔü 2. čĄĕëėâúěâåüğãňĕĢéĊĔøùěþĆēčèåŋãĐèâĈěŇĄøĆèâĔü 3. čĄĕëėâčüúüĕĠĈēþĆęâČĕĢüčėħèúĘħğþŎüþĆēġąëüŋøŇĐâĈěŇĄ 4. čĄĕëėâġøňĠąňèâĔü÷ňĊąğĎøěÿĈĠĈēĎĈĔââĕĆ ģĄŇüĬĕåĊĕĄĆĜňčęâčŇĊüøĔĊĠĈēĐåøėĄĕğâĘħąĊãňĐè 5. ĠĄňĄĘâĕĆãĔ÷ĠąňèâĔüĢü÷ňĕüåĊĕĄåė÷ ĠøŇčĄĕëėâúěâåüąĔèğøĦĄĢéúĘħéēğþŎüčŇĊüĆŇĊĄãĐèâĈěŇĄ 6. âĕĆāėéĕĆöĕåĊĕĄĄěŇèčĆňĕèčĆĆåŋ ĠĈēĠâňþŌîĎĕĢüâĕĆúĬĕèĕü ģĄŇğþŎüâĕĆĊėéĕĆöŋğĆĚħĐèčŇĊüøĔĊ 7. âĕĆøĔ÷čėüĢé÷ĬĕğüėüâĕĆãĐèâĈěŇĄğþŎüģþġ÷ąåĊĕĄğĎĦüĆŇĊĄâĔüğþŎüčŇĊüĢĎîŇýüāĚĨüòĕüãĐèåĊĕĄùĜâøňĐèĠĈē åĊĕĄ÷Ę 8. úěâåüąĐĄĆĔýĢüåĊĕĄčĕĄĕĆùãĐèâĔüĠĈēâĔü 9. ÿĜňüĬĕĠĈēÿĜňĆŇĊĄèĕüģĄŇýĘýýĔèåĔýìęħèâĔüĠĈēâĔü 10. ĄĘâĕĆøĆĊéčĐýâĕĆúĬĕèĕüãĐèúĘĄğþŎüĆēąēĥ

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âĕĆþĆēëěĄåöēâĆĆĄâĕĆýĕèåĆĔĨèâĦĄĘâĕĆùâğùĘąèâĔüýňĕè ìęħèğþŎüğĆĚħĐè ûĆĆĄ÷ĕĠĈēğþŎüčėħèúĘħ÷ĘğāĚħĐĢĎňúĆĕýåĊĕĄåė÷ğĎĦüĠĈēĄěĄĄĐèúĘħĠøâøŇĕè ğĄĚħĐĄĘ ğĎøě÷ĔèâĈŇĕĊâĕĆ÷ĬĕğüėüâĕĆĢüúĘħþĆēëěĄøňĐè 1. ğþľ÷ġĐâĕčĢĎňĠč÷èåĊĕĄåė÷ğĎĦüğøĦĄúĘħ 2. ĎĈĘâğĈĘħąèâĕĆāĜ÷ğĆĚħĐèčŇĊüøĔĊ 3. ĄěŇèþĆēğ÷ĦüģþúĘħãňĐãĔ÷Ġąňè 4. ĐąŇĕĢëňăĕČĕ÷ĜùĜâ ĎĈĘâğĈĘħąèâĕĆğčĘą÷čĘ 5. ğåĕĆāåĊĕĄåė÷ğĎĦüĠĈēþĆēčýâĕĆöŋ 6. ąę÷ĎĈĔâğĎøěÿĈ ĢëňĎĈĔâòĕüãňĐĄĜĈ čŇĊüĐěþčĆĆåčĬĕåĔîĢüâĕĆúĬĕèĕüğþŎüúĘĄúĘħāýĄĔâĄĕéĕâþŌééĔąøŇĕèĥ ğĎĈŇĕüĘĨģ÷ňĠâŇ 1. ãĕ÷âĕĆĊĕèĠÿü/ĠüĊúĕèþñėýĔøė 2. ģĄŇĄĘâĕĆĠýŇèèĕü/âĆēéĕąèĕüúĘħëĔ÷ğéü 3. åĬĕčĔħèúĘħģĄŇëĔ÷ğéü/ğþĈĘħąüĠþĈèýŇĐąĥ 4. ãĕ÷âĕĆøė÷øĕĄèĕüúĘħ÷Ę 5. ãĕ÷âĕĆčĐüèĕü âĕĆĠüēĠüĊúĕè 6. ģĄŇģ÷ňĠýŇèèĕüøĕĄåĊĕĄùüĔ÷ 7. ãĔĨüøĐüþñėýĔøėèĕüģĄŇëĔ÷ğéü 8. ãĕ÷âĕĆþĆēčĕüèĕüĎĆĚĐÿĜňĆĔýÿė÷ëĐý 9. ãĕ÷âĕĆåĊýåěĄåěöăĕāĆēĎĊŇĕèþñėýĔøėèĕü 10. ģĄŇģ÷ňåĬĕüęèùęèåĊĕĄāĆňĐĄĎĆĚĐþŌééĔąčĬĕåĔî øĈĐ÷ĆēąēğĊĈĕĢüâĕĆğþŎüâĆĆĄâĕĆčĄĕåĄĒ úĘħüĘħğĊĈĕĄĘþŌîĎĕâĦéēčĕĄĕĆùúĬĕåĊĕĄğãňĕĢéâĔüģ÷ňĢüúĘħþĆēëěĄ ğþŎüčŇĊüĢĎîŇ âĆĆĄâĕĆĄĘåĊĕĄčĄĔåĆčĄĕüčĕĄĔååĘâĔü÷Ę ìęħèùĚĐğþŎüéě÷úĘħ÷ĘĎĆĚĐéě÷ĠãĦèãĐèĐèåŋâĕĆ âĆĆĄâĕĆĄĘåĊĕĄĆĔý ÿė÷ëĐýĢüèĕüĠĈēğĐĕĢéĢčŇāĐčĄåĊĆúĬĕĢĎňğâė÷ÿĈèĕüøŇĕèĥ ĄĕĐąŇĕèĄĕâĄĕą âĦĄúĘ èĨĔ úĘğħ čĆĦéčĄýĜĆöŋĠĈēąĔèģĄŇčĄýĜĆöŋ Ģü÷ňĕüãĐèčĄĕëėââĦģ÷ňĆĔýåĊĕĄĆŇĊĄĄĚĐéĕâčĄĕëėâāĐčĄåĊĆøĈĐ÷ĆēąēğĊĈĕúĘħÿŇĕüĄĕ

ƒØu“š§œršr† þŌîĎĕĢüĊėëĕëĘāĠĈēğþŎüþŌîĎĕãĐèÿĜňþĆēâĐýĊėëĕëĘāúĔĨèúĘħğþŎüğéňĕãĐèâėéâĕĆĎĆĚĐÿĜňþñėýĔøėâĕĆĄĘĐąĜŇĄĕâĄĕą ĠĈēøŇĐğüĚĐħ èĄĕğþŎüğĊĈĕüĕü ģ÷ňĠâŇ ğĆĚĐħ èâĕĆĠãĊüþŃĕą ğĆĚĐħ èãĐèéĆėąûĆĆĄâĕĆĠãŇèãĔüġ÷ąĢëňčèåĆĕĄĆĕåĕ âĕĆåěâåĕĄéĕâ ĆňĕüąĕğåĆĚĐãŇĕąúĘģħ ĄŇĄğĘ ăčĔëâĆ ğþŎüøňü ìęèħ þŌîĎĕğĎĈŇĕüĘğĨ âė÷ãęüĨ ğāĆĕēğăčĔëâĆ÷ňĊąâĔüğĐèúĔèĨ üĔüĨ úĘþħ ĈŇĐąĢĎňÿĐňĜ üħĚ ĢëňĊî ė îĕö ãĐèøüĢüâĕĆĠčĊèĎĕÿĈþĆēġąëüŋġ÷ąģĄŇåĕĬ üęèùęèøĔĊýúâðĎĄĕą ĠĈēÿĈâĆēúýúĘÿħ ýňĜ ĆėġăåĎĆĚĐþĆēëĕëüéēģ÷ňĆýĔ éĕâ âĕĆĢëňąĕúĘģħ ĄŇùâĜ øňĐè ìęèħ ĐĕéùęèĠâŇëĊĘ øė ĎĆĚĐāėâĈāėâĕĆģ÷ň þŌîĎĕğĎĈŇĕüĘĨģĄŇčĕĄĕĆùĠâňģ÷ňġ÷ąčĄĕåĄĒ ĠøŇÿĜňğ÷ĘąĊğāĆĕē

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þŌééĔąøŇĕèĥ úĘħúĬĕĢĎňğâė÷þŌîĎĕĄĕéĕâăĕąüĐâøĔĨèĠøŇ ğĆĚħĐèâĕĆčĔħèčĐüĐýĆĄéĆėąûĆĆĄĢüăĕåâĕĆċęâČĕ âĕĆ ýĔ è åĔ ý Ģëň â ðĎĄĕąãĐèăĕåĆĔ ò Đė ú ûė ā ĈúĕèâĕĆğĄĚ Đ è ĐėúûėāĈĢüúňĐèùėħüëěĄëü ğăčĔëâĆĢüčĕãĕĐĚħüĥ úĘħĢëňëĚħĐ øüģþĠãĊüĢĎň ÷ĔèüĔĨüâĕĆĠâňþŌîĎĕüĔýĊĔüéēąĕâãęĨüĥ ğāĆĕēĆňĕüąĕğĎĈŇĕüĘĨĄĘĄĕâãęĨüúěâĊĔüğþľ÷ġ÷ąģĄŇåĬĕüęèùęè âðĎĄĕą ğëŇü âĕĆãĕąąĕĐĔüøĆĕąġ÷ąģĄŇĢëŇğăčĔëâĆ ġ÷ą ğêāĕēĆňĕüąĕúĘğħ þŎüĈĜâġìŇúøħĘ ĐŇ ĄĕâĦãĕąĠĂĆüģëčŋĄâĘ ĕĆãąĕą øĔĊĐąŇĕèĄĕâĠĈēğþľ÷øĈĐ÷ 24 ëĔĊħ ġĄè ąėèħ ģ÷ňþĆēġąëüŋĠĈē ĄĘåĊĕĄčĕĄĕĆùĢüâĕĆĠãŇèãĔüúĘħĄĕââĊŇĕğāĆĕēøňüúěüúĘħøħĬĕâĊŇĕĠĈēĆĕąģ÷ňúĘħĄĕéĕâĎĈĕąúĕèĄĕââĊŇĕĆňĕüąĕğ÷ĘħąĊ ãĕą ąĕġ÷ąģĄŇéĕĬ ğþŎüøňĐèĄĘğăčĔëâĆ ĎĆĚĐĆňĕüãĕąąĕúĘğħ þľ÷ĢüĆňĕüčē÷ĊâìĚĐĨ úĘĄħ âĘ ĕĆãĕąčěĆĕ ğåĆĚĐħ è÷ĚĄħ úĘĄħ ĠĘ ĐĈâĐđĐĈŋìèħę úĕèâĐè åĊýåěĄġĆåġ÷ą ā.Ć.ý.ĊŇĕ÷ňĊąğåĆĚĐħ è÷ĚĄħ ĠĐĈâĐđĐĈŋâģĦ ÷ňâĕĬ Ďü÷ëĔ÷ğéüĊŇĕĆňĕüąĕãĕąčėèħ ğĎĈŇĕüĘģĨ ĄŇģ÷ň ĠøŇâğĦ þľ÷âĔüĐąŇĕèğąňą âðĎĄĕą éēğĎĦüģ÷ňĊŇĕĆĔòýĕĈúĘħþĆēâĕċøĔĊĊŇĕéēğþŎüüėøėĆĔò ĠøŇĄĘâĕĆúĬĕÿė÷âðĎĄĕąâĔüĐąŇĕèġéŊèåĆęħĄ úĘħüĘħþĆēğúċģúą... ĐüĕåøãĐèÿĜňþĆēâĐýĊėëĕëĘāĠĈēğþŎüğéňĕãĐèâėéâĕĆøňĐèþĆĔýğþĈĘħąüģþøĕĄþŌééĔąúĘħğþĈĘħąüĠþĈèĢĎňģ÷ňğāĚħĐčĆňĕè åĊĕĄģ÷ňğþĆĘąýĢüâĕĆĠãŇèãĔüġ÷ąĢëňé÷ě ĠãĦèúĘĄħ ĐĘ ąĜĠŇ ĈēġĐâĕčúĘāħ ĐéēĄĘýĕň è ìęèħ ğþŎüğĆĚĐħ èúĘúħ ĕĬ ģ÷ňùĕň ĄĘåĊĕĄøĔèĨ Ģé üĔüħ åĚĐâĕĆ čĆňĕèåĊĕĄĠøâøŇĕèéĕâĆňĕüąĕĐĚħüĥ ĢüąŇĕüğ÷ĘąĊâĔü ĐĕéğþŎüúĕèăĕāĈĔâČöŋãĐèĆňĕüġ÷ą 5 č. ĐĕéğþŎüğĆĚħĐèãĐè ýĆĆąĕâĕċĢüĆňĕü ĆĜþĠýýâĕĆĢĎňýĆėâĕĆúĕèğăčĔëâĆĆĄúĘĠħ øâøŇĕèéĕâĆňĕüĐĚüħ âĕĆğüňüğêāĕēúĕèãĐèâĈěĄŇ ĈĜâåňĕğþŃĕĎĄĕą âĕĆĆĊĄâĈěŇĄĆňĕüąĕúĘħčüėúâĔüĢüâĕĆéĔ÷ìĚĨĐĆŇĊĄâĔüĎĆĚĐĢëňĆēýýâĕĆúĬĕèĕüğ÷ĘąĊâĔü ĢëňëĚħĐĎĆĚĐøĆĕčĔîĈĔâČöŋğ÷ĘąĊâĔü ğëŇüğ÷ĘąĊâĔýĆňĕüąĕĈĜâġìŇğāĚħĐÿĈĢüâĕĆøŇĐĆĐèĠĈēĎĕĆĕąģ÷ňéĕâåŇĕĊĕèčėüåňĕĎĆĚĐĠüēüĬĕčėüåňĕëüė÷ğ÷ĘąĊâĔüúĘħĄĘğêāĕē čĄĕëėâğåĆĚĐãŇĕą ġ÷ąčĄĕåĄĒ éēøňĐèúĬĕĎüňĕúĘħĢüâĕĆčüĔýčüěüĢĎňğâė÷ãęĨüĢüâĈěŇĄčĄĕëėâğĎĈŇĕüĘĨğāĚħĐčĆňĕèåĊĕĄğãňĄ ĠãĦèĠøŇčĄĕëėâøňĐèåěąâĔüğĐèâŇĐü ýĆėĎĕĆéĔ÷âĕĆâĔüğĐèâŇĐü ğþŎüøňü ĐĕéĄĘĎĈĕąğåĆĚĐãŇĕąĎĆĚĐğåĆĚĐãŇĕąğ÷ĘąĊġ÷ąĢëň âĆĐýâøėâĕğ÷ĘąĊâĔüúĘħčĄĕåĄĒ âĬĕĎü÷ğāĚħĐģĄŇĢĎňĠãŇèâĔüğĐèĄĕâğâėüģþ ğāĆĕēĎĕâéēĠãŇèâĦĠãŇèĢüğĆĚħĐèåěöăĕā âĕĆ ýĆėâĕĆúĘħĎĈĕâĎĈĕąĠĈēĐĕéĠøâøŇĕèâĔüģ÷ň

iš‹¤r}ҕ‹˜‚‚’ jˆš† âĕĆúĘħĆňĕüąĕğþŎüčŇĊüĎüęħèĢüĆēýýčěãăĕāüĔýğþŎüğĆĚħĐèúĘħčĬĕåĔîãĐèĊėëĕëĘāğāĆĕēÿĜňģ÷ňþĆēġąëüŋĄĕâúĘħčě÷åĚĐ þĆēëĕëüğāĆĕēéēúĬĕĢĎňâĕĆģ÷ňĆĔýýĆėâĕĆéĕâğăčĔëâĆĢüğĆĚħĐèąĕĄĘåĊĕĄčĬĕåĔîøŇĐþĆēčėúûėăĕāĠĈēþĆēčėúûėÿĈéĕâąĕ ĐąŇĕèğøĦĄúĘħ ğāĆĕēğăčĔëâĆéē÷ĜĠĈĢüğĆĚħĐèãĐè DRP (Drug related problem) ĢĎňĠâŇÿĜňþłĊąģ÷ň÷ĘúĘħčě÷ĄĕââĊŇĕýěåĈĕâĆ úĕèâĕĆĠāúąŋčĕãĕĐĚħüĥ ĠüŇüĐü üĐâéĕâüĘĨâĕĆğëĚħĐĄøŇĐĆēýýčěãăĕāąĔèúĬĕĢĎňğăčĔëâĆëěĄëüĄĘâĕĆāĔõüĕċĔâąăĕā ĢüâĕĆ÷ĜĠĈÿĜňþłĊąģ÷ňĄĕâąėħèãęĨüġ÷ąğêāĕēâĕĆüĬĕúĔâČēĄĕĢëňĢüâĕĆ÷ĜĠĈÿĜňþłĊąéēğāėħĄāĜüãęĨüğþŎüĐąŇĕèĄĕâ êýĔýüĘÿĨ ĄãĐéýğāĘąèğúŇĕüĘâĨ ĐŇ üğāĆĕēĎĕâğãĘąüğąĐēåüéēģĄŇĐĕŇ üéüĎĄ÷ êýĔýĎüňĕúŇĕüýĆĆöĕûėâĕĆĢĎňÿĄğãĘąü øŇĐĐĘâ ĠĈňĊāýâĔüĢĎĄŇåĆĔýĎĈĔèéĕâĈèéĕâøĬĕĠĎüŇèüĕąâčĄĕåĄĒ ĠĈňĊ čĊĔč÷ĘåĆĔý....

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ÿĜňğãĘąüģ÷ňĆĔýĎüĔèčĚĐ ğĐâčĕĆþĆēâĐýčĄĔëëĕğăčĔëâĆĆĄģúą 97 þĿ “åĊĕĄĆĔýÿė÷ëĐýãĐèğăčĔëâĆģúą ĢüâĕĆ þñėýøĔ èė ĕüĢüĆňĕüąĕ” ìęħèéĔ÷úĬĕġ÷ąåöēâĆĆĄâĕĆĐĬĕüĊąâĕĆéĔ÷þĆēëěĄğøĆĘąĄâĕĆčĄĔëëĕğăčĔëâĆĆĄģúą 100 þĿ (ā.ċ. 2556) ĆŇĊĄâĔýčĄĕåĄğăčĔëâĆĆĄëěĄëü (þĆēğúċģúą) ğĄĚħĐÿĜňğãĘąüģ÷ňĐŇĕü÷ĜĆĕąĈēğĐĘą÷ăĕąĢü ģ÷ňþĆēéĔâČŋĠéňèĊŇĕğþŎü ĎüĔèčĚĐúĘħ÷ĘğĈŇĄĎüęħèãĐèĊėëĕëĘāğăčĔëâĆĆĄ üĐâéĕâéēâĈŇĕĊùęèþĆēĊĔøėċĕčøĆŋãĐèĊėëĕëĘāğăčĔëâĆĆĄĊŇĕâŇĐâĬĕğüė÷Ąĕ éĕâģĎüĐąŇĕèģĆĠĈňĊ ąĔèģ÷ňýĆĆéěãňĐĄĜĈ øĔĊğĈã čùėøėãĐèčùĕüâĕĆöŋãĐèâĕĆþĆēâĐýĊėëĕëĘāğăčĔëâĆĆĄĢüþŌééěýĔü ąėħè âĊŇĕüĔĨü ĄĘâĕĆĄĐèģþãňĕèĎüňĕùęèĐüĕåøãĐèâĕĆþĆēâĐýĊėëĕëĘāğăčĔëâĆĆĄĊŇĕéēğþŎüģþĢüúėċúĕèĢ÷ ğăčĔëâĆåĊĆ øňĐèğøĆĘąĄĢéĠĈēğøĆĘąĄøĔĊĆĔýĄĚĐâĔýåĊĕĄğþĈĘħąüĠþĈèĐĔüúňĕúĕąĢüĐüĕåøĐĔüĢâĈňüĘĨĐąŇĕèģĆ ÿĜňğãĘąüĢåĆŇãĐğüňüąĨĬĕĊŇĕ ùňĕğĆĕğþŎüğăčĔëâĆĠĈňĊ üĐâéĕâéēøňĐèĄĘĎüĔèčĚĐğĈŇĄüĘĨ ğĆĕąĔèøňĐèĐŇĕüĎüĔèčĚĐğĈŇĄüĘĨĢĎňéý÷ňĊą ĄĔüéēúĬĕĢĎňğĆĕĢâĈňëė÷ âĔýčĄĕåĄĒ ãĐèāĊâğĆĕ ĠĈēğãňĕĢéĊėčĔąúĔċüŋúĘħ÷ĘãĐèčăĕğăčĔëâĆĆĄĄĕâąėħèãęĨü ĢüýúåĊĕĄčĔĨüĥ üĘĨ ÿĜňğãĘąüéēãĐĎąėýąâ ýĕèþĆēğ÷ĦüúĘħčĬĕåĔîĢüĎüĔèčĚĐĄĕğâĆėħüüĬĕĢĎňāĊâğĆĕğāĚħĐĎĕĎüĔèčĚĐğĈŇĄüĘĨ ĠĈňĊċęâČĕĎĕåĊĕĄĆĜňâĔý “ĊėëĕëĘāğăčĔëâĆĆĄ” ãĐèāĊâğĆĕøŇĐģþ

pši¥†ŠÖƒ‹ oŠš‰š¤ƒÚiš‹‚‹œ‚š¤ˆ’™ri‹‹‰ čĄğ÷ĦéāĆēğéňĕýĆĄĊèċŋğûĐâĆĄāĆēąĕëĔąüĕúüğĆüúĆ ĢüĆĔëčĄĔąāĆēýĕúčĄğ÷ĦéāĆēĄèâěðğâĈňĕğéňĕĐąĜŇĎĔĊ úĆèéĔ÷ øĔĨèĠÿüâĠāúąŋþĆěèąĕ ġĆèğĆĘąüĆĕëĠāúąĕĈĔąøĔĨèĠøŇĊĔüúĘħ 8 ûĔüĊĕåĄ ā.ċ.2456 éĕâüĔĨüģ÷ňĄĘâĕĆāĔõüĕĊėëĕëĘā ğăčĔëâĆĆĄĠĈēâĕĆċęâČĕğăčĔëċĕčøĆŋøŇĐğüĚħĐèĄĕġ÷ąøĈĐ÷éüâĕĆčĕûĕĆöčěããĐèġĈâģ÷ňāĔõüĕâĕĆĢĎňýĆėâĕĆúĕè ğăčĔëâĆĆĄúĘħâŇĐÿĈþĆēġąëüŋčĜèčě÷øŇĐåüģãňĊŇĕ “âĕĆýĆėýĕĈğăčĔëâĆĆĄ” âĕĆāĔõüĕĢüĈĔâČöēĐèåŋĆĊĄãĐèĆēýý čĕûĕĆöčěãüĘħğĐè úĘħúĬĕĢĎňğăčĔëâĆúĘħþĆēéĬĕĐąĜŇĢüĆňĕüąĕĄĘýúýĕúĐąŇĕèĄĕâĢüĆēýýčĕûĕĆöčěããĐèģúą ġ÷ąúĘħ FIP (International Pharmaceutical Federation) ìęħèğþŎüÿĜňüĬĕ÷ňĕüâĕĆāĔõüĕýúýĕúãĐèĊėëĕëĘāğăčĔëâĆĆĄĆē÷ĔýčĕâĈ âĈŇĕĊùęèåěöĈĔâČöēčĬĕåĔîãĐèğăčĔëâĆúĘāħ èę ĄĘĢüâĕĆ÷ĜĠĈÿĜþň Ċł ąģ÷ňğãňĕĄĕĄĘýúýĕúøŇĐğăčĔëâĆëěĄëüüĘ÷Ĩ Ċň ąĢâĈňë÷ė ĄĕâãęüĨ ĢüâĕĆüĘĨ úĕèčĄĕåĄğăčĔëâĆĆĄëěĄëüâĦøĆēĎüĔâùęèþŌîĎĕâĕĆþñėýĔøėĊėëĕëĘāëěĄëü ġ÷ąúŇĕüüĕąâčĄĕåĄĒ ăâ.ûĘĆĊěõė āèċŋğċĆČòģāċĕĈģ÷ňâĈŇĕĊüĬĕĢüčĕĆĢüòĕüēþĆēûĕüåöēúĬĕèĕü čĕãĕğăčĔëâĆĆĄëěĄëüģĊňøĐüĎüęèħ ĊŇĕ “...ğüĚĐħ èéĕâ ğăčĔëâĆčŇĊüĢĎîŇąĔèģĄŇğĎĦüĊŇĕĆňĕüąĕğþŎüâĕĆþĆēâĐýĊėëĕëĘāĐąŇĕèĠúňéĆėè ğāĚħĐþĆēëĕëüĠĈēĄĘåĊĕĄčĬĕåĔî

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øŇĐĆēýýčĕûĕĆöčěããĐèþĆēğúċ...” âĕĆâňĕĊąŇĕèğãňĕčĜŇ 100 þĿğăčĔëâĆĆĄģúąéęèğþŎüâĕĆğĆŇèĠâňþŌîĎĕøŇĕèĥ ĢüâĕĆ þĆēâĐýĊėëĕëĘāğăčĔëâĆĆĄĢüĆňĕüąĕ ġ÷ąĄĘâĕĆþĆēëěĄğčĊüĕĎĈĕâĎĈĕąĢüĎĈĕąĎĔĊãňĐ ğëŇü ĎĔĊãňĐ “åěöăĕāĠĈē åĊĕĄčĬĕåĔîãĐèąĕčĄěüģāĆģúą åěöåŇĕĠĎŇèâĕĆ÷ĜĠĈĆĔâČĕčěãăĕāĢüĆňĕüąĕ”, “åěöăĕāĠĈēċĔâąăĕāĐěøčĕĎâĆĆĄąĕ ĢüþĆēğúċ ĐüĕåøĠĈēúėċúĕèâĕĆāĔõüĕüĊĔøâĆĆĄąĕ” ġ÷ąğêāĕēĢüĎĔĊãňĐĎĈĔèüĘĨ ÷Ć.ăâ.čěëĕøė éĐèþĆēğčĆėò ĎĔĊĎüňĕ âĈěŇĄĐěøčĕĎâĆĆĄąĕčĕĄĔîĠĈēúĆĔāąŋčėüúĕèþŌîîĕ čĬĕüĔâèĕüåöēâĆĆĄâĕĆĐĕĎĕĆĠĈēąĕ ğþŎüĊėúąĕâĆýĆĆąĕą ğĆĚħĐè “åěöăĕāĠĈēċĔâąăĕāĐěøčĕĎâĆĆĄąĕĢüþĆēğúċ” úŇĕüĊėúąĕâĆģ÷ňĂŌüûèĈèģþğĈąĊŇĕ ĄĕøĆòĕüĠĈēåěöăĕāãĐè ąĕúĘħÿĈėøĢüþĆēğúċģúąĎĆĚĐúĘħğĆĘąâĊŇĕ Generic Drugs üĔĨüĄĘåěöăĕāĢüĆē÷Ĕýğ÷ĘąĊâĔýąĕøňüøĬĕĆĔý (Original Drugs) úěâþĆēâĕĆ ğāĆĕēğúåġüġĈąĘ ĊėëĕâĕĆ÷ňĕüğăčĔëâĆĆĄãĐèģúąĄĘåĊĕĄâňĕĊĎüňĕĢüĆē÷ĔýčĕâĈĠĈňĊ ĠĈēğþŎüåĊĕĄéĬĕğþŎü úĘħøňĐèÿĈėøąĕĢĎňģ÷ňĄĕøĆòĕü GMP, PICs ğāĚħĐĢĎňúĔüâĔýâĕĆğþľ÷þĆēëĕåĄĐĕğëĘąü (AEC) Ģü 4 þĿãňĕèĎüňĕüĘĨ (÷ĜĆĕą ĈēğĐĘą÷ģ÷ňĢüýúåĊĕĄ “ąĕëĚħĐčĕĄĔîĠĈēąĕëĚħĐøňüøĬĕĆĔý : åĊĕĄğĎĄĚĐüĢüëĚħĐøŇĕè”, ăâ.Ċėčěúûėī čěĆėąĕăėĊĔõüŋ; ĊèâĕĆąĕ øěĈĕåĄ 2553)

lš‰}ӕoiš‹iš‹‚‹œiš‹¤ˆ’™ri‹‹‰i™‚‹˜‚‚’ jˆš†¬¤ƒ¬Š¥ƒo¨ƒ ĢüĎüĔèčĚĐģ÷ňĄĐèģþãňĕèĎüňĕùęèþŌîĎĕĠĈēčùĕüâĕĆöŋ÷ňĕüčĕûĕĆöčěããĐèģúąúĘħĄĘâĕĆğþĈĘħąüĠþĈèĢüğâĚĐýúěâ ÷ňĕü ġ÷ąčĆěþģĊňğþŎü 12 þĆēğ÷Ħü÷ňĊąâĔü ğëŇü ™ čùĕüâĕĆöŋãĐèġĆåğâė÷éĕâāćøėâĆĆĄčĔèåĄğĄĚĐèúĘħğþŎüçĕøâĆğèĘąýçŇĕëĘĊėøÿĜňåü ĐĔüģ÷ňĠâŇ ġĆååĊĕĄ÷Ĕü ğýĕ ĎĊĕü ĠĈēĄēğĆĦè ĠĈēâĕĆĠāĆŇĆēýĕ÷ãĐèġĆåģãňĎĊĔ÷üâ SARS ĠĈēģãňĎĊĔ÷ĢĎîŇāĔüûěŋĢĎĄŇëüė÷ H1N1 2009 úĬĕĢĎňĆňĕü ąĕøňĐèĄĘčŇĊüĆŇĊĄĢüâĕĆåĔ÷âĆĐèġĆåğýĚĨĐèøňüğāĚħĐčŇèøŇĐģþąĔèčùĕüāąĕýĕĈøŇĐģþ  ™čĔèåĄģúąâĬĕĈĔèğãňĕčĜŇčĔèåĄÿĜňčĜèĐĕąěĠĈēġĆåğĆĚĨĐĆĔè ğþŎüăĕĆēĢĎňĠâŇýěåĈĕâĆúĕèâĕĆčĕûĕĆöčěã (ĆĊĄúĔĨè ğăčĔëâĆëěĄëü÷ňĊą) úĘħøňĐèĆĔýÿė÷ëĐý÷ĜĠĈÿĜňčĜèĐĕąěğĎĈŇĕüĘĨğāėħĄĄĕâãęĨü (÷ĜĆĕąĈēğĐĘą÷ģ÷ňéĕâýúåĊĕĄ “Microtrends ğþľ÷ġĐâĕčĢĎňĆňĕüąĕğ÷ĘħąĊ; ĊĕĆčĕĆčĄĕåĄğăčĔëâĆĆĄëěĄëüĒ êýĔýāćČăĕåĄ 2553)  ™āćøėâĆĆĄåĊĕĄğčĘħąèúĕèğāċčĔĄāĔüûŋ üĬĕĄĕìęħèġĆåğĐ÷čŋ  ™ĐĕâĕĆģĄŇāęèþĆēčèåŋéĕââĕĆĢëňąĕ ĐĕĎĕĆğčĆėĄ ĠĈēčĄěüģāĆúĘħğāėħĄĄĕâãęĨü ğāĆĕēĄĘâĕĆãęĨüúēğýĘąüøĬĕĆĔý ąĕğþŎüéĬĕüĊüĄĕâ ĠøŇąĔèãĕ÷ĆēýýâĕĆøė÷øĕĄåĊĕĄþĈĐ÷ăĔąĐąŇĕèĢâĈňëė÷ ĐĘâúĔĨèĄĘâĕĆúĬĕâĕĆøĈĕ÷ĠýýãĕąøĆè ġçČöĕġĐňĐĊ÷ğâėüéĆėè ìęħèğþŎüĐĘâýúýĕúĎüňĕúĘħãĐèğăčĔëâĆëěĄëüúĘħøňĐèĢĎňãňĐğúĦééĆėèúĘħğþŎüþĆēġąëüŋøŇĐÿĜňýĆėġăåĢĎňģ÷ň  ™åŇĕĢëňéŇĕą÷ňĕüąĕĄĕâğâėüéĬĕğþŎü þĆēğúċģúąĄĘåŇĕĢëňéŇĕą÷ňĕüąĕĄĕâùęèĆňĐąĈē 43 ãĐèåŇĕĢëňéŇĕą÷ňĕüčěãăĕā (ãňĐĄĜĈþĿ ā.ċ.2548) ãöēúĘħþĆēğúċāĔõüĕĠĈňĊĄĘåŇĕĢëňéŇĕą÷ňĕüąĕģĄŇğâėüĆňĐąĈē 20 ğúŇĕüĔĨü ÷ĔèüĔĨü âĕĆúĘħğăčĔëâĆëěĄëü éēĎĔüĄĕĢëňąĕëĚħĐčĕĄĔîéęèğþŎüĐĘâýúýĕúĎüęħèúĘħëŇĊąĈ÷åŇĕĢëňéŇĕą÷ňĕüąĕģ÷ň  ™þŌîĎĕâĕĆĢëňąĕĐąŇĕèĂ쳥ğĂŁĐą ÷ňĕüąĕþñėëĘĊüē âĕĆĢëňąĕëě÷ ąĔèğþŎüþŌîĎĕúĘħĆĐâĕĆĠâňģãĐąŇĕèğĆŇè÷ŇĊü ğăčĔëâĆëěĄëüéēĄĘýúýĕúčĬĕåĔîĢüâĕĆúĬĕĎüňĕúĘħüĘĨ  ™âĕĆġçČöĕ âĕĆčŇèğčĆėĄâĕĆãĕą âĕĆãĕąøĆèąĔèåèåěâåĕĄčĊĔč÷ėăĕāãĐèþĆēëĕëüÿĜňýĆėġăå  ™þŌîĎĕâĕĆĂŃĐèĆňĐèýěåĈĕâĆ÷ňĕüčĕûĕĆöčěãĄĘĄĕâãęĨü éēþŃĐèâĔüģ÷ňùňĕğâė÷åĊĕĄğãňĕĢéĆēĎĊŇĕèÿĜňĢĎňýĆėâĕĆ 34


ĠĈēÿĜňĆĔýýĆėâĕĆ ĆĊĄúĔĨèâĕĆúĘħĄĘâðĎĄĕąĊėûĘāėéĕĆöĕå÷ĘÿĜňýĆėġăå ĠĈēåĊĕĄĆĔýÿė÷ øŇĐåĊĕĄğčĘąĎĕąúĘħğâė÷éĕâčėüåňĕúĘħģĄŇþĈĐ÷ăĔą úĘħĐĐâýĔèåĔýĢëňğĄĚħĐ ā.ċ.2551 úĘħ ğþľ÷ëŇĐèĢĎňĄĘâĕĆģâĈŇğâĈĘħąğéĆéĕâĔü éēĄĘýúýĕúčĬĕåĔîąėħèĢüâĕĆāĔõüĕåěöăĕā ãĐèâĕĆĢĎňýĆėâĕĆ  





 ™âĕĆğþľ÷ğčĆĘúĕèâĕĆåňĕĠĈēâĕĆĈèúěü ġ÷ąğêāĕēâĕĆğþľ÷ĢĎňüâĔ ĈèúěüĐĕğëĘąüčĕĄĕĆùğãňĕùĚĐĎěüň ģ÷ňĄĕâùęèĆňĐąĈē

70 éēğþŎüúĔĨèþĆēġąëüŋĠĈēăĔąåěâåĕĄĢüğĊĈĕğ÷ĘąĊâĔü ãęĨüâĔýĊŇĕĆňĕüąĕéēğøĆĘąĄāĆňĐĄĢüĆē÷ĔýĢ÷  ™âðğâöôŋúĘħğþĈĘħąüĠþĈèģþ ĢüğĆĚħĐèãĐèâðâĆēúĆĊèğâĘħąĊâĔýâĕĆøŇĐĢýĐüěîĕøĆňĕüąĕúĘħøňĐèĢĎňĄĘğăčĔëâĆĐąĜŇ þñėýĔøėâĕĆøĈĐ÷ğĊĈĕĠĈēĄĕøĆòĕüâĕĆĢĎňýĆėâĕĆ øĈĐ÷éüĎĈĔâčĜøĆğăčĔëċĕčøĆŋúĘħğþĈĘħąüğþŎü 6 þĿ éēúĬĕĢĎňĊėëĕëĘā ğăčĔëâĆĆĄĐąĜŇĆŇĊĄâĔýĊėëĕëĘāčĕûĕĆöčěãĐĚħüĥ ģ÷ň÷ĘãęĨü ĠøŇýúýĕúĢü÷ňĕüâĕĆğþŎüÿĜňþĆēâĐýĐĕéĈ÷üňĐąéĕèĎĕąģþģ÷ň ìęħèĄĘÿĈâĆēúýøŇĐĆňĕüąĕğ÷ĘħąĊĐąŇĕèĠüŇüĐü

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ĢüăĕåÿüĊâĐĔüğþŎüýúčě÷úňĕąãĐèĎüĔèčĚĐğĈŇĄüĘĨ ģ÷ňøāĘ Ąė āŋèĕüĊėéąĔ “þŌééĔąúĘĄħ Ę ÿĈøŇĐâĕĆģĄŇĐąĜþŇ ñėýøĔ âė ĕĆãĐèğăčĔëâĆþĆēéĬĕĆňĕüąĕ âĆöĘċâę ČĕéĔèĎĊĔ÷Ďüęèħ ” ìęèħ ğþŎü èĕüĊėéĔąãĐèåöēğăčĔëċĕčøĆŋ ĄĎĕĊėúąĕĈĔąüğĆċĊĆ ģ÷ňâĈŇĕĊģĊňĢüýúåĔ÷ąŇĐģĊňĊŇĕ þŌééĔąúĘħĄĘÿĈøŇĐâĕĆğâė÷ĆňĕüąĕĠãĊüþŃĕą āýĊŇĕĆňĕüąĕĢ÷úĘħğăčĔëâĆğþŎüğéňĕãĐèéē ģĄŇğþŎüĆňĕüąĕĠãĊüþŃĕą ĠøŇĆňĕüãĕąąĕúĘħğéňĕãĐèĆňĕüãĕąąĕģĄŇĢëŇğăčĔëâĆ ğéňĕãĐè þĆēčèåŋéēğþŎüÿĜň÷ĬĕğüėüâėéâĕĆğĐèĄĕââĊŇĕúĘħéēĢĎňğăčĔëâĆğãňĕĄĕąěŇèğâĘħąĊâĔýâėéâĕĆãĐèĆňňĕü üĐâéĕâüĘĘĨąĔèþĆĕâñþŌééĔą ĐĚħü ğëŇü ğăčĔëâĆøňĐèâĕĆåŇĕøĐýĠúü âĕĆøňĐèğ÷ėüúĕèĆēąēģâĈĆēĎĊŇĕèúĘħúĬĕèĕüâĔýĆňĕüãĕąąĕ åĊĕĄğĎüĦ÷ğĎüĚħĐąéĕâ èĕüþĆēéĬĕ ĠĈēåĊĕĄģĄŇğãňĄèĊ÷ãĐèâĕĆýĔèåĔýĢëňâðĎĄĕą ĐąŇĕèģĆâĦ÷Ę ĢüâĕĆċęâČĕåĆĔĨèüĘĨ ĄĘâĕĆĈèāėĄāŋåĬĕčĔĄăĕČöŋãĐèÿĜňþĆēâĐýâĕĆúĘħģĄŇĢëŇğăčĔëâĆãĐèĆĐèüĕąĠāúąŋ čĕûĕĆöčěãéĔèĎĊĔ÷ ìęħèğĎĦüĊŇĕâĕĆĄĘğăčĔëâĆĐąĜŇþĆēéĬĕĆňĕüğþŎüĐěþčĆĆåøŇĐÿĈþĆēġąëüŋúĕèûěĆâėéĆňĕüąĕ ìęħèÿĜňğãĘąüğĎĦü ĊŇĕğþŎüğĆĚħĐèûĆĆĄ÷ĕãĐèâĕĆāĕöėëąŋ ĠøŇúĘħÿĜňğãĘąüøė÷ĢéĄĕâåĚĐ ĄĘåĬĕčĔĄăĕČöŋãĐèğăčĔëâĆüėĆüĕĄĎĈĕąúŇĕüúĘħüŇĕčüĢé Ąĕâ úĘħāĊâğĆĕğăčĔëâĆ÷ňĊąâĔüøňĐèëŇĊąâĔüåė÷ĊėğåĆĕēĎŋåĬĕčĔĄăĕČöŋğĎĈŇĕüĘĨĢĎň÷ĘĊŇĕ čùĕüâĕĆöŋğëŇüüĘĨéēĐąĜŇåĜŇĊėëĕëĘā āĊâğĆĕģþĐĘâüĕüčĔâğúŇĕģĆéęèéēùęèéě÷ğþĈĘħąüĠþĈè ĈĐèĂŌè÷ĜčėåĆĔý... “...āĘħĄĕĠãĊüþŃĕąúĘħĆňĕüąĕüĘĨ ģ÷ňåŇĕøĐýĠúüĄĕââĊŇĕúĘħģ÷ňéĕâġĆèāąĕýĕĈ ğéňĕãĐèĆňĕüâĦģĄŇģ÷ňýĔèåĔýĢĎňāĘħøňĐèģþĐąĜŇ úĘħĆňĕü÷ňĊą éēģþøĐüģĎüâĦģ÷ň ùňĕāĘħģĄŇĄĕĠãĊüþŃĕąĢĎňğãĕ ğãĕâĦéēģþĎĕåüĐĚħüĄĕĠãĊüþŃĕąĢĎňĐąĜŇ÷Ę...” “...ğĄĚħĐâŇĐüāĘħâĦğþľ÷ĆňĕüãĐèøĔĊğĐè øĐüüĘĨğìňèĢĎňüňĐèúĘħğþŎüğéňĕāüĔâèĕüğăčĔëâĆĆĄúĘħúĬĕèĕüĢüúĘħğ÷ĘąĊâĔü āĘħâĦĠãĊü þŃĕąĢĎňğãĕ üňĐèğãĕĄĘåĊĕĄĆĜňğĆĚħĐèąĕĐąĜŇýňĕè úĬĕĢĎňģĄŇøňĐèĎŇĊèĠĈēģþĐąĜŇĆňĕüþĆēéĬĕ ģĊňĢéğãĕğāĆĕēğĆĕúĬĕèĕü÷ňĊąâĔüĄĕ üĕü ĆĜňüėčĔąâĔü...” “...ĆňĕüąĕĠãĊüþŃĕąĄĘĎĈĕąĆňĕü ùňĕéēýĔèåĔýāĘħĢĎňģþĐąĜŇúĘħĆňĕüâĦčĕĄĕĆùúĬĕģ÷ň ĠøŇéēøňĐèĢĎňĆňĕüúĘħĠãĊüþŃĕąĐąĜŇ úĔĨèĎĄ÷þñėýĔøėĢĎňğĎĄĚĐüĥ âĔü éēģ÷ňģĄŇğâė÷åĊĕĄğĎĈĚħĐĄĈĨĬĕ...” ĎĕâāĊâğĆĕĐŇĕüãňĐåĊĕĄãňĕèøňüüĘĨĠĈňĊ åė÷ĊŇĕåèéēĎĕåĬĕøĐýģ÷ňģĄŇąĕâĊŇĕ “ĢåĆ” åĚĐÿĜňúĬĕĈĕąğâĘąĆøėċĔâ÷ėīĠĎŇè ĊėëĕëĘāğăčĔëâĆĆĄ???

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‚’‹ ƒ āĊâğĆĕúĘħğåąģ÷ňëĄăĕāąüøĆŋģúąğĆĚħĐè “ġĎĄġĆè” ĐĕééēéĬĕùňĐąåĬĕãĐèåĆĜčĐü (ċĆ) üĔâĆēüĕ÷ğĐâìęħèğþŎüøĔĊğĐâ ãĐèğĆĚĐħ èúĘâħ ĈŇĕĊùęè÷üøĆĘģúą ĊĔõüûĆĆĄĢüčĄĔąÿĜüň ĕĬ ğÿ÷ĦéâĕĆúĘþħ ĆĕĆùüĕéēúĬĕĈĕąĈňĕè÷üøĆĘģúąĠĈēĊĔõüûĆĆĄģúąğāĚĐħ åĊĕĄúĔüčĄĔąãĐèčąĕĄþĆēğúċģĊňĊĕŇ “øňüģĄňĢĎîŇéēúüøŇĐĠĆèāîĕëňĕèčĕĆģ÷ňâøĦ Đň èĄĘĆĕâúĘĎħ ąĔèħ ĈęâĀŌèĠüŇüĈèģþĢü÷ėü” ĎĕâøňüģĄňĢĎîŇğþĆĘąýğþŎüĊėëĕëĘāğăčĔëâĆĆĄ ĆĕâãĐèøňüģĄňâĦåĚĐøĔĊğăčĔëâĆúěâåü ĠĈēĠĆèāîĕëňĕèčĕĆâĦüŇĕéēğþĆĘąý ģ÷ňâĔýğéňĕãĐèĆňĕüãĕąąĕĎĆĚĐåŇĕéňĕèĠãĊüþŃĕą ĊėëĕëĘāğăčĔëâĆĆĄéēĄĔħüåèøňĕüúĕüúüĠĆèãĐèāîĕëňĕèčĕĆģ÷ň øĔĊ ğăčĔëâĆúěâåüéēøňĐèğþŎü “Ćĕâ” úĘħĎąĔħèĈęâĀŌèĠüŇüĈèĢü÷ėü ğāĚħĐāąěèøňüģĄňĢĎîŇģĊňĢĎňģ÷ň ğāĆĕēĎĕâģĄŇĄĘģĄňĢĎîŇĠĈňĊâĦéē ģĄŇğĎĈĚĐĆĕâ ĠĈēģĄŇĄĘĆĕâĠĈňĊøňüģĄňĢĎîŇâĦåèĐąĜŇģĄŇģ÷ňğëŇüâĔü éĕâĠāúąŋþĆěèąĕĄĕğþŎüýĆėýĕĈğăčĔëâĆĆĄ Ġč÷èĊŇĕĊėëĕëĘāğăčĔëâĆĆĄĄėģ÷ňþñėğčûåĊĕĄğéĆėîâňĕĊĎüňĕúĕèĊėëĕâĕĆ ãĐèġĈâøēĊĔüøâ ĠøŇüŇĕğčĘą÷ĕąúĘħāĊâğĆĕâĔüğĐèģĄŇĆĜňéĔâýúýĕú ĎüňĕúĘħ åĊĕĄĆĔýÿė÷ëĐý ãĐèĊėëĕëĘāğăčĔëâĆĆĄ ĠĄňĠøŇ ăĕåâĕĆċęâČĕâĦĄěŇèğüňüĠĈēĎĈèþĈĚĨĄĠøŇğĆĚħĐèĊėëĕâĕĆéüğâėüģþ ĠøŇĄĐèãňĕĄåĊĕĄčĬĕåĔîãĐèâĕĆčĆňĕè “ğăčĔëâĆøĔĊéĆėè” úĬĕĢĎňÿĈėøăĔöôŋ (éĬĕüĊüĎüęħèúĘħĄĘĄĕâùęèčĕĄĢüčĘħ ãňĐĄĜĈéĕâèĕüĊėéĔąãňĕèøňü) úĘħÿĈėøĐĐâéĕâġĆèèĕüåöēğăčĔëċĕčøĆŋ ğþŎüÿĜňúĘħúĬĕĈĕąĠâŇüĆĕâãĐèĊėëĕëĘāğăčĔëâĆĆĄ÷ňĊąâĕĆĠãĊüþŃĕąĆňĕüãĕąąĕ ÷ĔèúĘħúŇĕüüĕąâčĄĕåĄĒ ăâ.ûĘĆĊěõėâĈŇĕĊ ģĊňĊŇĕ “...ğüĚħĐèéĕâğăčĔëâĆčŇĊüĢĎîŇąĔèģĄŇğĎĦüĊŇĕĆňĕüąĕğþŎüâĕĆþĆēâĐýĊėëĕëĘāĐąŇĕèĠúňéĆėè...” ÿĜňğãĘąü÷ĘĢéĄĕâúĘħĄĘâĕĆĠâňģãâĕĆþñėýĔøėâĕĆãĐèğăčĔëâĆëěĄëüĢüĐèåŋĆĊĄăĕąĢøňâĕĆüĬĕãĐèčăĕğăčĔëâĆĆĄ ĠøŇâĕĆ ĠâňģãþŌîĎĕĢĎîŇĎĈĊèĐąŇĕèĠãĊüþŃĕąúĘħğĆĚĨĐĆĔèĄĕüĕüùęè 98 þĿĠĈňĊ éēĢĎňčĬĕğĆĦéĈěĈŇĊèăĕąĢüĐĘâčĐèþĿãňĕèĎüňĕåèøňĐè ĄĘ “þĕñėĎĕĆėąŋ” ğâė÷ãęĨüâŇĐüĠüŇ ĠøŇùęèĐąŇĕèģĆâĦøĕĄ ĎĕâĄĘåĊĕĄþĆĕĆùüĕĐąŇĕèĠĆèâĈňĕãĐèčăĕğăčĔëâĆĆĄúĘħéēĠâňģã þŌîĎĕâĕĆĠãĊüþŃĕąĢĎňčĬĕğĆĦéĈěĈŇĊè âĦģĄŇüŇĕéēğþŎüğĆĚħĐèąĕâ ğāĆĕēåĬĕøĐýğ÷ĘąĊúĘħéēĠâňģãâĕĆĠãĊüþŃĕąģ÷ňéēøňĐèğĆėħĄ øňüúĘħğăčĔëâĆğúŇĕüĔĨü ĠĈēùňĕāĊâğĆĕğþŎüğăčĔëâĆøĔĊéĆėè åĬĕøĐýğ÷ĘąĊüĔĨüåĚĐ “ğĆėĄħ øňüúĘøħ ĊĔ ğĆĕğĐè” ğ÷ĘĪąĊüĘĨ... ğúŇĕüĔĨüğĐè... éĆėèĥ ýĆĆöĕüěâĆĄ : ğĐâčĕĆþĆēâĐýčĄĔëëĕğăčĔëâĆĆĄģúą 97 þĿ “åĊĕĄĆĔýÿė÷ëĐýãĐèğăčĔëâĆģúąĢüâĕĆþñėýĔøėèĕüĢüĆňĕüąĕ”; ĊĔüāěûúĘħ 8 ûĔüĊĕåĄ 2553 ö ġĆèĠĆĄġĂĆŋĊėèčŋ čěãěĄĊėú 26 âĆěèğúāĒ; éĔ÷úĬĕġ÷ąåöēâĆĆĄâĕĆĐĬĕüĊąâĕĆéĔ÷þĆēëěĄğøĆĘąĄâĕĆčĄĔëëĕğăčĔëâĆĆĄģúą 100 þĿ (ā.ċ.2556)

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ğĄĚħĐ 14 ûĔüĊĕåĄ 2553 úĘħÿŇĕüĄĕ åöēĐüěâĆĆĄĕûėâĕĆāėéĕĆöĕċęâČĕþŌîĎĕĠĈē âĕĆāĔõüĕĊėëĕëĘāğăčĔëâĆĆĄĠĈēĆēýýąĕĢüĆēýýčěãăĕāãĐèëĕøė åöēâĆĆĄĕûėâĕĆâĕĆ čĕûĕĆöčěãĊěõėčăĕ ĆŇĊĄâĔýčăĕğăčĔëâĆĆĄ ĠĈēčĬĕüĔâèĕüĎĈĔâþĆēâĔüčěãăĕāĠĎŇèëĕøė ĆŇĊĄâĔüéĔ÷čĔĄĄüĕ ğĆĚĐħ è úėċúĕèâĕĆčŇèğčĆėĄåěöăĕāâĕĆĢëňąĕĢüĆēýýĎĈĔâþĆēâĔüčěãăĕā ö ġĆèĠĆĄĆĐąĔĈĆėğĊĐĆŋ âĆěèğúāĒ ğüĚħĐèéĕâģ÷ňøĆēĎüĔâùęèåĊĕĄčĬĕåĔîãĐèğĆĚħĐè÷ĔèâĈŇĕĊìęħè ğþŎüþŌîĎĕúĘħčŇèÿĈâĆēúýøŇĐåŇĕĢëňéŇĕą÷ňĕüčěãăĕā ĠĈēăĕĊēčěãăĕāãĐèþĆēëĕëüĢü ĆēąēąĕĊ ĠĈēğþŎüþŌîĎĕúĘħøňĐèâĕĆâĕĆĠâňþŌîĎĕúĔĨèĆēýý úĔĨèĢüčŇĊüãĐèâĕĆĢëňąĕ ĠĈē âĕĆÿĈėøąĕìęħèéēüĬĕģþčĜŇåĊĕĄĄĔħüåèãĐèþĆēğúċĢüâĕĆāęħèāĕøüğĐè÷ňĕüąĕ èĕüþĆēëěĄ åĆĔĨèüĘĨĄĘÿĜňğãňĕĆŇĊĄþĆēëěĄâĊŇĕ 200 åü éĕâăĕåčŇĊüøŇĕèĥ þĆēâĐý÷ňĊą ăĕåâĕĆğĄĚĐè ëĄĆĄ / ğåĆĚĐãŇĕąÿĜĢň ëňąĕ ĐèåŋâĆĊėëĕëĘā ğăčĔëâĆġĆèāąĕýĕĈ Ćňĕüąĕ čĬĕüĔâèĕüčĕûĕĆöčěã éĔèĎĊĔ÷ üėčėø / üĔâċęâČĕğăčĔëċĕčøĆŋ / čĬĕüĔâèĕüåöēâĆĆĄâĕĆĐĕĎĕĆĠĈēąĕ (Đą.) ĐèåŋâĆþâåĆĐèčŇĊüúňĐèùėħü åöĕéĕĆąŋéĕâåöēğăčĔëċĕčøĆŋ ğþŎüøňü ăĕąĢüâĕĆèĕüþĆēëěĄģ÷ňé÷Ĕ ĢĎňĄâĘ ĕĆĆē÷ĄčĄĐèĢĎňğâė÷åĊĕĄëĔ÷ğéüĢüĎĈĕąþĆēğ÷Ħü ğëŇü ’ˆš†ƒØu“šiš‹§rӊšj•oƒ‹˜ršr ¥pi¥po¨|ӓšŠ™i‘{˜ |™o­ 1. âĕĆĢëňąĕìĨĕĬ ìňĐü / ģ÷ňĆýĔ ąĕğâėüåĊĕĄéĬĕğþŎü / āćøėâĆĆĄâĕĆĢëňąĕģĄŇùâĜ øňĐè (âĕĆ ğĆĘąâĎĕąĕ) åĊĕĄğëĚħĐ 2. ĄĘåĊĕĄģĄŇğúŇĕğúĘąĄâĔüãĐèąĕúĘħĢëňĢüĆēýýþĆēâĔüčěãăĕāúĘħĠøâøŇĕèâĔü úĔĨèĢü ÷ňĕüåěöăĕā ĠĈēĄĜĈåŇĕąĕ 3. þŌîĎĕåěöăĕāâĕĆĢëňąĕ þŌîĎĕåěöăĕāĄĕøĆòĕüãĐèąĕ ĠĈēĄĕøĆòĕüèĕü ğăčĔëâĆĆĄĢüĎüŇĊąýĆėâĕĆ Ćňĕüąĕ 4. âĈěŇĄÿĜňþłĊąúĘħģĄŇčĕĄĕĆù÷ĜĠĈøĔĊğĐèģ÷ň ąĔèãĕ÷ÿĜň÷ĜĠĈ ìęħèĐĕééēğâĘħąĊğüĚħĐèéĕâ þŌééĔąøŇĕèĥ ĄĕâĄĕą ğëŇü âĕĆğãňĕùęèãňĐĄĜĈ ĠĈēåĊĕĄùĜâøňĐè åĆýùňĊüãĐèãňĐĄĜĈ÷ňĕüąĕ åĈėüėâĠāúąŋ ĄĔâéēģĄŇĄĘğăčĔëâĆĢĎňýĆėâĕĆ âĕĆ shopping ąĕ éĕâĎĈĕąĠĎĈŇè ãĕ÷åĊĕĄĆĜň åĊĕĄğãňĕĢé÷ňĕüąĕ ğëŇü ĢüğĆĚħĐèâĕĆéĔ÷ğâĦýąĕúĘħģĄŇğĎĄĕēčĄ ĆĊĄúĔĨèãĕ÷âĕĆĄĘčŇĊüĆŇĊĄĢüâĕĆĆĔâČĕ 41


 



âĕĆġçČöĕëĊüğëĚħĐãĐèÿĈėøăĔöôŋčěãăĕā  ãĕ÷åĊĕĄğëĚĐ ħ ĄġąèĆēĎĊŇĕèĆňĕüąĕĠĈēġĆèāąĕýĕĈ ĠĈēãĕ÷ĆēýýâĕĆğãňĕùęèĠĈēčŇèøŇĐãňĐĄĜĈúĘéħ ĕĬ ğþŎüčĬĕĎĆĔý ğăčĔëâĆĢüâĕĆ÷ĜĠĈÿĜňþłĊąĆŇĊĄâĔüãĐèýěåĈĕâĆúĕèâĕĆĠāúąŋ ĆĊĄúĔĨèãĕ÷âĕĆčĚħĐčĕĆúĘħčĆňĕèåĊĕĄğãňĕĢéâĔü÷Ę ýüāĚĨüòĕüãĐèĊėëĕëĘāğ÷ĘąĊâĔüĠĈēĄĘúĔċüåøėúĘħ÷ĘøŇĐâĔü  âĕĆğãňĕùęèąĕģ÷ňèŇĕą (éüğâėüģþ) 

úĘħþĆēëěĄğĎĦüĆŇĊĄâĔüĊŇĕ “ğăčĔëâĆ” ĄĘåĊĕĄčĬĕåĔîøŇĐâĕĆĢĎňýĆėâĕĆĢüĆēýýčěãăĕā úĬĕĢĎňčĕĄĕĆùĢëňąĕģ÷ňĐąŇĕè ùĜâøňĐè þĈĐ÷ăĔą ĆňĕüąĕúĘħĄĘğăčĔëâĆčĕĄĕĆùøĐýčüĐèåĊĕĄøňĐèâĕĆãĐèÿĜňþłĊąĠĈēÿĜňĆĔýýĆėâĕĆøĆèčŇĊüüĘĨģ÷ňĐąŇĕè÷Ę ğþŎüúĘħüŇĕāęèāĐĢé ÷ňĊąğĎøěüĘĨĆĔòéęèåĊĆĄĘýúýĕúčĬĕåĔîĢüâĕĆúĘħéēëŇĊąğĎĈĚĐ ĠĈēčüĔýčüěüĢĎňĆňĕüąĕğăčĔëâĆčĕĄĕĆù ÷ĬĕĆèâėéâĕĆĐąĜŇģ÷ň ĠĈēĄĘâĕĆâĆēéĕąøĔĊĐąŇĕèğúŇĕğúĘąĄâĔüĢüúĔħĊúěâăĜĄėăĕåãĐèþĆēğúċ ġ÷ąĐĕé÷ĬĕğüėüâĕĆĢüĆĜþĠýý ãĐèâĕĆåĊýåěĄéĬĕüĊüġåĊøĕĆňĕüąĕ ĆēýýâĕĆéĔ÷âĕĆğĆĚħĐèâĕĆğèėüúĘħéēčüĔýčüěü ğāĚħĐĢĎňĄĘâĕĆâĆēéĕąúĘħúĔħĊùęèĄĕâãęĨü ĠĈē “ğăčĔëâĆøĔĊéĆėè” ĢüĆňĕüąĕ åĊĆĄĘâĕĆĠč÷èøüúĘħëĔ÷ğéüğāĚħĐĢĎňÿĜňĄĕĆĔýýĆėâĕĆčĕĄĕĆùúĆĕýģ÷ňġ÷ąèŇĕą ğëŇü âĕĆ čĊĄğčĚĨĐâĕĊüŋúĘħĄĘčĔîĈĔâČöŋãĐèčăĕğăčĔëâĆĆĄ ĎĆĚĐâĕĆĄĘĆĜþùŇĕąãĐèğăčĔëâĆĠč÷èģĊňĢüúĘħğþľ÷ğÿą ğþŎüøňü üĐâéĕâ üĔĨüĆĔòéęèåĊĆéĔ÷ĆēýýĢĎňğâė÷åĊĕĄğþŎüûĆĆĄĢüâĕĆĢĎňýĆėâĕĆâĔýÿĜňþłĊąĢüĆēýýâĐèúěüþĆēâĔüčěãăĕāĠýýøŇĕèĥ üĐâéĕâüĔĨüąĔèĄĘâĕĆĆē÷ĄčĄĐèğāĚħĐĎĕĠüĊúĕèčŇèğčĆėĄåěöăĕāâĕĆĢëňąĕãĐèþĆēëĕëüĢĎň÷ĘãęĨü ìęħèāýĊŇĕĄĘ ĄĕøĆâĕĆčĬĕåĔî 3 þĆēâĕĆ ÷ĔèüĘĨ ‰š}‹iš‹¬ 1 : †™zšiš‹¤r¦Šo‚‹œiš‹‹˜“Òšo¤ˆ’™ri‹¦‹o†Šš‚š¥˜¤ˆ’™ri‹r ‰r øĔèĨ “åöēúĬĕèĕüãĔýğåĈĚĐħ üâĕĆğëĚĐħ ĄġąèýĆėâĕĆúĕèğăčĔëâĆĆĄĆēĎĊŇĕèğăčĔëâĆġĆèāąĕýĕĈĠĈēĆňĕüąĕåěöăĕā” ġ÷ą ĄĘýúýĕúĎüňĕúĘħčĬĕåĔî 4 þĆēâĕĆ 1. âĕĆéĔ÷âĕĆğëėèĆēýýĢĎňĄĘ Focal point ĢüâĕĆğëĚħĐĄġąè 2 ĎüŇĊąèĕü ìęħèøňĐèčĄĔåĆĢéúĔĨè 2 Āłĕą 2. ĆŇĊĄéĔ÷úĬĕĠüĊþñėýĔøėĢüâĕĆåňüĎĕĠĈēĠâňþŌîĎĕéĕââĕĆĢëňąĕ (âĆöĘÿĜňþłĊąüĐâ) 3. ĆŇĊĄāĔõüĕğåĆĚħĐèĄĚĐĢüâĕĆ÷ĜĠĈÿĜňþłĊą ğëŇü čĄě÷ýĔüúęââĕĆĢëňąĕ (Ġýý ĠĂŃĄğøėĄ) ĠĈēĠýýĂĐĆŋĄâĕĆčĚħĐčĕĆĆēĎĊŇĕèâĔüčĬĕĎĆĔýġĆåğýĕĎĊĕü åĊĕĄ÷ĔüĒ ĎĐýĎĚ÷ HIV 4. āĔõüĕâėéâĆĆĄğāĚħĐčĆňĕèåĊĕĄčĔĄāĔüûŋĆēĎĊŇĕè 2 čŇĊü ğëŇü úĬĕġåĆèâĕĆ ĆöĆèåŋ čüĔýčüěüĢĎňğâė÷åĊĕĄĆŇĊĄĄĚĐğĆėħĄğĆĚħĐèèŇĕąĥ ‰š}‹iš‹¬ 2 iš‹¤†œ¬‰’‰‹‹~˜¤ˆ’™ri‹ƒx‰ˆ¡‰œ čŇèğčĆėĄğăčĔëâĆĆňĕüąĕĠĈēġĆèāąĕýĕĈ åĊĆĄĘâĕĆğĆĘąüĆĜňĆŇĊĄâĔü ġ÷ąĢëňâĈĊėûĘ ğëŇü   âĕĆčĆňĕèğĊúĘĢüâĕĆğĆĘąüĆĜňĆŇĊĄâĔüĆēĎĊŇĕèğăčĔëâĆĢüāĚĨüúĘħ 42


ĄĘâĕĆĀŀâþñėýĔøėèĕüãĐèğăčĔëâĆĆňĕüąĕĠĈēğăčĔë ġĆèāąĕýĕĈĆŇĊĄâĔü   ĄĘâĕĆčĆňĕèğåĆĚĐãŇĕąğăčĔëâĆĢüāĚĨüúĘħğāĚħĐčĆňĕèåĊĕĄ čĔĄāĔüûŋĐüĔ ÷ĘĢüâĕĆúĬĕèĕüĆēĎĊŇĕèâĔü (ëĄĆĄğăčĔëþĆēéĬĕéĔèĎĊĔ÷), âĈěŇĄčĎĊėëĕëĘā, MOU ĐąŇĕèģĆâĦøĕĄ âĆēýĊüâĕĆğāėħĄčĄĆĆùüēĢüĠüĊúĕèãňĕèøňü éēğâė÷ãęĨüģ÷ňøňĐèĄĘğèĚħĐüģãčĬĕåĔîåĚĐ âĕĆāĔõüĕ ĆēýýĠĈēüġąýĕąğëĚħĐĄĆēĎĊŇĕèĆňĕüąĕĠĈēġĆèāąĕýĕĈ 



‰š}‹iš‹¬ 3 iš‹’™‚’ pši•olÖi‹ˆšl’ҏ¬¤i¬Šjӕo âĕĆğāėħĄåěöăĕāâĕĆĢëňąĕãĐèþĆēëĕëü éĬĕğþŎüøňĐèģ÷ňĆĔýâĕĆčüĔýčüěüéĕâúěâăĕåčŇĊüúĘħğâĘħąĊãňĐè ğëŇü   čăĕğăčĔëâĆĆĄ ğþŎüğéňĕăĕāĎĈĔâ þĆēčĕüăĕåĘúĘħğâĘħąĊãňĐè ÷ĬĕğüėüâĕĆąâĆē÷ĔýåěöăĕāâĕĆĢëňąĕãĐè þĆēğúċ âĕĆĐĐâĄĕøĆòĕüĊėëĕëĘāğăčĔëâĆĆĄëěĄëü   čĄĕåĄġĆèāąĕýĕĈ čĄĕåĄğăčĔëâĆĆĄëěĄëü čŇèğčĆėĄčĄĕëėâĢĎňĄĄ Ę ĕøĆòĕüâĕĆþñėýøĔ èė ĕüĢüĄĕøĆòĕü ğ÷ĘąĊâĔü   ğăčĔë ččé. åĊĆëŇĊąĢüâĕĆéĔ÷âĕĆğëėèĆēýý ğëĚħĐĄġąèâĔýĎüŇĊąýĆėâĕĆĐĚħüĥ ĢĎňğâė÷ğĐâăĕā   čþčë. åĊĆčüĔýčüěüèýþĆēĄĕöĢĎňğăčĔëâĆğāĚħĐĠâňģãþŌîĎĕâĕĆĢëňąĕ ġ÷ąĐĕéÿĈĔâ÷ĔüĢĎňğþŎüøĔĊëĘĨĊĔ÷ ĠĈē åĊĆâĬĕĎü÷ğþŎüğâöôŋĄĕøĆòĕüãĐèĎüŇĊąýĆėâĕĆĢĎňĄĄĘ ĕøĆòĕüâĕĆĢĎňýĆėâĕĆčŇèğčĆėĄåěöăĕāâĕĆĢëňąĕĐąŇĕè þĆēëĕëü   Đą. åĊĆéĔ÷úĬĕòĕüãňĐĄĜĈâĕĆĢëňąĕ úĘħğĎĄĕēčĄâĔýâĕĆğÿąĠāĆŇ ğāĚħĐåěöăĕāâĕĆĢëňąĕ ġ÷ąøňĐèøĆèøĕĄåĊĕĄ øňĐèâĕĆãĐèÿĜňýĆėġăå   čùĕýĔüâĕĆċęâČĕ åĊĆčüĔýčüěüĊėëĕâĕĆ čĬĕĎĆĔýğăčĔëâĆ (Ćňĕüąĕ/Ćā.) ĢĎňāõ Ĕ üĕċĔâąăĕāâĕĆýĆėâĕĆ ĆĊĄúĔèĨ ğøĆĘąĄåĊĕĄāĆňĐĄĢĎňüĔâċęâČĕğăčĔëċĕčøĆŋ ĠĈēþĈĜâĀŌèğĆĚħĐèâĕĆĄĘéėøčĕûĕĆöē Ćċ.÷Ć.úĆèċĔâ÷ėī ċĆĘĐüěëĕøė þĆēûĕüåöēĐüěâĆĆĄĕûėâĕĆāėéĕĆöĕċęâČĕþŌîĎĕĠĈēâĕĆāĔõüĕĊėëĕëĘāğăčĔëâĆĆĄ ĠĈēĆēýýąĕĢüĆēýýčěãăĕāãĐèëĕøė Ċěõėčăĕ ģ÷ňâĈŇĕĊøĐüĎüęħèĢüëŇĊèčĆěþâĕĆčĔĄĄüĕĊŇĕ “...âĕĆčĆěþÿĈâĕĆþĆēëěĄ ĊĔüüĘĨéēğþŎüãňĐĄĜĈģþþĆēâĐýâĔýâĕĆċęâČĕãĐèåöēĐüěâĆĆĄĕûėâĕĆĒ üĬĕģþéĔ÷úĬĕğþŎüãňĐčĔèğâø ãňĐğčüĐĠüē ãĐèåöēâĆĆĄâĕĆûėâĕĆĒ ğāĚħĐüĬĕğčüĐĊěõėčăĕĢĎňĄĘĄøė÷ĬĕğüėüâĕĆĐąŇĕèĎüęħèĐąŇĕèĢ÷ ġ÷ąğêāĕēĐąŇĕèąėħèĄøė čŇèÿĈâĕĆċęâČĕĠĈēãňĐğčüĐĠüēøŇĐĀłĕąýĆėĎĕĆ ġ÷ąüĕąâĆĔòĄüøĆĘøňĐèüĬĕğčüĐåöēĆĔòĄüøĆĘĢĎňĄĘĄøėĊŇĕéē ÷ĬĕğüėüâĕĆĐąŇĕèĎüęħèĐąŇĕèĢ÷ ĎĈĔèéĕâüĔĨüĆĔòýĕĈéēģ÷ňĠéňèÿĈâĕĆ÷ĬĕğüėüâĕĆĄĕąĔèĊěõėčăĕ ĊŇĕģ÷ň÷ĬĕğüėüâĕĆ ĐąŇĕèģĆ øė÷ãĔ÷ĐąŇĕèģĆ ĄĘãňĐğčüĐĢüâĕĆĠâňģãĐąŇĕèģĆ…” ãňĐčĆěþéĕââĕĆčĔĄĄüĕĢüåĆĔĨèüĘĨ ąĨĬĕĢĎňğĆĕğĎĦüĊŇĕ åĊĕĄĆŇĊĄĄĚĐâĔüĆēĎĊŇĕèğăčĔëâĆġĆèāąĕýĕĈĠĈēğăčĔëâĆĆňĕüąĕ ĄĘåĊĕĄéĬĕğþŎüøŇĐâĕĆčŇèğčĆėĄåěöăĕāâĕĆĢëňąĕãĐèþĆēëĕëü ...åèùęèğĊĈĕĠĈňĊúĘħĊėëĕëĘāğăčĔëâĆĆĄéēÿüęââĬĕĈĔè ĐąŇĕèĠúňéĆėèğāĚħĐþĆēġąëüŋčěããĐèþĆēëĕëü 43


ÂÒáÅСÒÃ㪌ÂÒ

ăâ.âėøėąċ ąċčĄýĔøė ĠĈē ăî.čėĆėüěë āĈēăėîġî čùĕüþñėýĔøėâĕĆğăčĔëâĆĆĄëěĄëü (ġĐčùċĕĈĕ) åöēğăčĔëċĕčøĆŋ éěďĕĈèâĆöŋĄĎĕĊėúąĕĈĔą

Clinical case in community pharmacy ršŠ“ ҉¥˜“uœo’š •šŠ ƒ‹˜‰š{ 30 ƒÊ ‰šj•sŸ­• Diamox® p±š 40 ¤‰«| Diamox® lŸ•rï•iš‹lӚj•oŠš•˜¨‹? ¥˜‰jӕ‚Òo§rӕŠÒšo¨‹‚Óšo? ëĚħĐčĕĄĔîãĐè Diamox® åĚĐ acetazolamide ìęħèğþŎüąĕĢüâĈěŇĄ carbonic anhydrase inhibitor (CAI) úĘħčĕĄĕĆù ąĔýąĔĨèâĕĆúĬĕèĕüãĐè carbonic anhydrase ĐĔüğþŎüğĐüģìĄŋúĘħĄĘýúýĕúčĬĕåĔîĢüâĕĆãĔýĐĐâãĐè hydrogen ion úĘħúŇĐ ģø ĠĈēâĕĆ÷Ĝ÷âĈĔýãĐè sodium, potassium, bicarbonate üĐâéĕâüĘĨ carbonic anhydrase ąĔèğâĘħąĊãňĐèâĔýâĕĆčĆňĕè aqueous humor ĢüĈĜâøĕ ĠĈēâĕĆğâė÷čĔîîĕöþĆēčĕúúĘħÿė÷þâøėéĕâğìĈĈŋčĄĐèãĐèÿĜňþłĊąĈĄëĔâ ÷ňĊąâĈģâúĘħâĈŇĕĊ ĄĕüĘĨ ąĕĢüâĈěŇĄ CAI éęèĄĘãňĐýŇèĢëňúĘħĎĈĕâĎĈĕą1 ģ÷ňĠâŇ 1) čĬĕĎĆĔýÿĜňþłĊąġĆåĎĈĐ÷ğĈĚĐ÷ĠĈēĎĔĊĢé ĢëňğþŎüąĕãĔýþŌččĕĊē (diuretic) 2) čĬĕĎĆĔýÿĜňþłĊąġĆåøňĐĎėü (glaucoma) ĢëňĈ÷ĠĆè÷ĔüĢüĈĜâøĕ ĠĈē 3) čĬĕĎĆĔýÿĜňþłĊąġĆåĈĄëĔâ (centrencephalic epilepsy) ĢëňğþŎüąĕøňĕüëĔâ (anti-epileptic drug)

pšiiš‹’•‚~š‰„¡Ó‰š‹™‚‚‹œiš‹™­o’•o ƒ‹šiwÒšƒwœ¤’€¦‹lƒ‹˜p±š}™}Қoª ¥}҉šj•sŸ­•Šš­ ¤†ï• ‹™‚ƒ‹˜šiҕiš‹¨ƒ¤¬ŠƒÊ¤jš¬}Қoƒ‹˜¤ Šš acetazolamide ‰jӕ‚Òo§rӝ¬¤i¬Šjӕoi™‚’~šiš‹{ց­•ŠÒšo¨‹? Acetazolamide ĄĘãňĐýŇèĢëňĢüâĕĆþŃĐèâĔüăĕĊē acute mountain sickness (AMS) ìęħèğþŎüăĕĊēúĘħğâė÷ãęĨüĢüÿĜňúĘħ ĐąĜŇĢüúĘħčĜèâĊŇĕĆē÷ĔýüĨĬĕúēğĈøĔĨèĠøŇ 2,400 ğĄøĆ (8,000 Ăěø) ãęĨüģþ ġ÷ąāýĄĕâĢüÿĜňúħãĘ ęĨüčĜŇúĘħčĜèĆē÷ĔýüĘĨĐąŇĕèĆĊ÷ğĆĦĊ (åĚĐ éĕâúĘħĆē÷ĔýüĨĬĕúēğĈãęĨüģþąĔèĆē÷ĔýúĘħčĜèâĊŇĕ 3,000 ğĄøĆ Ģü 24 ëĔħĊġĄèĎĆĚĐãęĨüúĘħčĜèĢüĆēąēĄĕââĊŇĕ 600 ğĄøĆøŇĐĊĔü ğĄĚħĐ ĐąĜŇčĜèâĊŇĕĆē÷ĔýüĨĬĕúēğĈ 2,500 ğĄøĆãęĨüģþ) ğëŇü ĢüÿĜňúĘħþĿüğãĕčĜèġ÷ąģĄŇģ÷ňĎąě÷āĔâëŇĊèĆēĎĊŇĕèğ÷ėüúĕè ÿĜňúĘħĢëňâĆēğëňĕ ĈĐąĂŃĕĎĆĚĐğåĆĚħĐèýėü úĬĕĢĎňĄĘâĕĆğþĈĘħąüãĐèåĊĕĄâ÷ĐĕâĕċăĕąĢüĆēąēğĊĈĕĐĔüéĬĕâĔ÷2 ˆš˜ AMS ‰•šiš‹¥˜i¨iiš‹¤iœ|¦‹l¤ƒÚ•ŠÒšo¨‹? AMS ğþŎüĐĕâĕĆúĘħğâė÷ãęĨüğüĚħĐèéĕââĕĆãęĨüģþąĔèúĘħčĜè ĢüĆēąēğĊĈĕĐĔüčĔĨüúĬĕĢĎňâĆēýĊüâĕĆ acclimatization ğâė÷ ãęĨüģĄŇúĔüâĔýâĕĆĈ÷ĈèãĐèĠĆè÷ĔüĐĐâìėğéüĢüĐĕâĕċ ìęħèāýģ÷ňĄĕââĊŇĕĆňĐąĈē 25 ĎĆĚĐ 1 Ģü 4 ãĐèüĔâúŇĐèğúĘħąĊğĄĚħĐãęĨü čĜŇúĘħčĜèĄĕââĊŇĕ 2,400 ğĄøĆ üĐâéĕâüĘĨâĕĆãĕ÷üĨĬĕ (dehydration) úĘħğþŎüÿĈĆĊĄéĕââĕĆğčĘąğĎèĚħĐĐąŇĕèĆĊ÷ğĆĦĊğĄĚħĐĐąĜŇĢü úĘħčĜèĠĈēâĕĆéĬĕâĔ÷þĆėĄĕöüĨĬĕ÷ĚħĄ éēĄĘÿĈğāėħĄġĐâĕčğâė÷ AMS ĄĕâąėħèãęĨü3 ĐĕâĕĆÿė÷þâøėãĐè AMS üĔĨüĄĔâĠč÷èãęĨüĎĈĔèéĕâüĔâúŇĐèğúĘħąĊãęĨüčĜŇúĘħčĜèĠĈňĊ 6-10 ëĔħĊġĄèĠĈē÷ĘãęĨüğĐèģ÷ňăĕąĢü 24-72 ëĔħĊġĄèĎĕâğâė÷âĆēýĊüâĕĆ acclimatization ģ÷ňĐąŇĕèĄĘþĆēčėúûėăĕā ĐĕâĕĆãĐè AMS úĘħāýýŇĐąģ÷ňĠâŇ þĊ÷ 44


ċĘĆČē ĐŇĐüğāĈĘą ģĄŇčýĕąúňĐè åĈĚħüģčň/ĐĕğéĘąü ğýĚħĐĐĕĎĕĆ èŇĊèìęĄ Ąęüèè ĎĕąĢéãĔ÷ ĎĆĚĐĎĕąĢéĈĬĕýĕâġ÷ąğêāĕēğĄĚħĐøňĐèĐĐâĠĆè ĠĈēüĐüģĄŇĎĈĔýĎĆĚĐøňĐèøĚħüýŇĐą åĆĔĨèğüĚħĐèéĕââĕĆĎĕąĢéãĕ÷ëŇĊè ýĕèĆĕąĐĕéāý peripheral edema ĠĈēúňĐèğčĘą ģ÷ň 3 ĐĕâĕĆ AMS üĔĨüģĄŇĄĘåĊĕĄéĬĕğāĕē ĠĈēĐĕéčĔýčüâĔýġĆåĐĚħüģ÷ňèŇĕą ĐąŇĕèģĆâĦøĕĄüĔâúŇĐèğúĘħąĊåĊĆģ÷ňĆĔýâĕĆĠüēüĬĕĢĎňčĔèğâøĐĕâĕĆÿė÷þâøėãĐèøüğĐè ğāĚħĐåĊĕĄģĄŇþĆēĄĕúĠĈēĎąě÷âĕĆğ÷ėüúĕèãęĨüčĜŇúĘħčĜèâĊŇĕğ÷ėĄ ğüĚħĐèéĕâĎĕâģĄŇģ÷ňĆĔý âĕĆĆĔâČĕĠâňģãĐąŇĕèğĎĄĕēčĄ úĔüúŇĊèúĘ AMS ĐĕéāĔõüĕģþčĜŇĐĕâĕĆúĘħĆěüĠĆèĠĈē ĄĘĐĔüøĆĕąĄĕâãęĨüåĚĐ high altitude pulmonary edema (HAPE) ĠĈē high altitude cerebral edema (HACE) 4 •ipši AMS ¥Ó Š™o‰•šiš‹„œ|ƒi}œ•ï¬†‚¨|Ó¤‰ï•jž­’¡Ò¬’¡o¤‹«¤iœ¨ƒ“‹Ÿ•¨‰Ò? üĐâéĕâ AMS ĠĈňĊ ĐĕâĕĆÿė÷þâøėúĘħāýğĄĚħĐãęĨüčĜŇúĘħčĜèğĆĦĊğâėüģþúĘħāýģ÷ňĠĈēĄĘåĊĕĄĆěüĠĆèĄĕââĊŇĕ AMS åĚĐ high altitude pulmonary edema (HAPE) ĠĈē high altitude cerebral edema (HACE) ìęħèğþŎüĐĔüøĆĕąùęèĠâŇëĘĊėø ĎĕâģĄŇģ÷ňĆĔýâĕĆĆĔâČĕĐąŇĕèúĔüúŇĊèúĘĠĈēğåĈĚħĐüąňĕąÿĜňþłĊąĈèĄĕčĜŇĆē÷ĔýüĨĬĕúēğĈ 5 HAPE ğâė÷éĕââĕĆåĔħèüĨĬĕĠĈēãĐèğĎĈĊĢüğüĚĨĐğąĚħĐþĐ÷ úĬĕĢĎňþĆēčėúûėăĕāâĕĆĎĕąĢéĠĈēâĕĆĠĈâğþĈĘħąü ĐĐâìėğéüĈ÷Ĉè ÿĜňþłĊąĄĔâĄĘĐĕâĕĆåĈňĕąĎĈĐ÷ĈĄĐĔâğčý (bronchitis) ģ÷ňĠâŇ ĐĕâĕĆģĐĠĆè ğĆĚĨĐĆĔè ģĄŇĄĘğčĄĎēĢüĆēąē ĠĆâĠĈēğþĈĘħąüğþŎüĄĘğčĄĎēğþŎüĂĐèčĘĐĐâëĄāĜéĕââĕĆúħĘĄĘğĈĚĐ÷þüĢüğčĄĎē ĢüĆĕąúĘħğþŎüĄĕâĄĔâāýĐĕâĕĆģãňĠĈē ĎĕąĢéãĔ÷ĎĆĚĐĎĕąĢéĈĬĕýĕâ ìęħèğþŎüĠĄňéēģĄŇģ÷ňĄĘâėéâĆĆĄúĘħøňĐèĐĐâĠĆèĠøŇĐąŇĕèĢ÷ üĐâéĕâ acetazolamide ĠĈňĊ ąĔè ĄĘâĕĆċęâČĕúĘħĠč÷èùęèþĆēčėúûėăĕāãĐè nifedipine, tadalafil, sildenafil ĠĈē salmeterol úĘħĢëňĢüâĕĆþŃĐèâĔü HAPE5 HACE ğâė÷éĕââĕĆåĔħèüĨĬĕĠĈēãĐèğĎĈĊĢüčĄĐè ĐĕâĕĆúĘħāýčŇĊüĢĎîŇãĐè HACE åĚĐ ĐĕâĕĆþĊ÷ċĘĆČē ìęħè ĄĔâģĄŇøĐýčüĐèøŇĐąĕýĆĆğúĕþĊ÷ ğ÷ėüğì (øĬĕĆĕýĕèğĈŇĄĐûėýĕąĈĔâČöēãĐèÿĜňþłĊąĊŇĕğ÷ėüğìåĈňĕąğĊĈĕâĈėĨèùĔèğýĘąĆŋ) čøėčĔĄþëĔîîēĈ÷Ĉè ĠĈēåĈĚħüģčňĄĕâąėħèãęĨü ĎĕâąĔèģĄŇģ÷ňĆĔýâĕĆĠâňģãÿĜňþłĊąéēĄĘĐĕâĕĆčĔýčü ëĕ ğþŎüĐĔĄāĕø ġåĄĕ ĠĈēğčĘąëĘĊėøĢüúĘħčě÷ ąĕúĘħĄĘþĆēčėúûėăĕāĢüâĕĆþŃĐèâĔüĠĈēĠâňģã HACE åĚĐ dexamethasone 5 i¨iiš‹••iŒ€œ°j•o acetazolamide § AMS ¤ƒÚ•ŠÒšo¨‹ âĈģââĕĆĐĐâćúûėīãĐè acetazolamide ĢüâĕĆþŃĐèâĔü AMS ąĔèģĄŇğþŎüúĘħğãňĕĢéģ÷ňĐąŇĕèëĔ÷ğéü åĕ÷ĊŇĕâĕĆúĘħ ąĕĈ÷âĕĆãĔýĐĐâãĐè hydrogen ion ĆŇĊĄâĔýâĕĆğāėħĄ bicarbonate ĢüþŌččĕĊē úĬĕĢĎňğâė÷ăĕĊēþŌččĕĊēğþŎü÷ŇĕèĠĈē ğĈĚĐ÷ğþŎüâĆ÷ĄĕâãęĨü (metabolic acidosis) ìęħèâĆēøěňüĢĎňğâė÷âĕĆĎĕąĢéĢĎňğĆĦĊãęĨü (tachypnea) ÷ĔèüĔĨüéęèëŇĊąâĆēøěňü ĢĎňĆŇĕèâĕąģ÷ňĆĔýĐĐâìėğéüğāėħĄĄĕâãęĨü ğþŎüâĕĆĠâňģãăĕĊēĎĕąĢéĈ÷Ĉè ĠĈēâĕĆãĕ÷ĐĐâìėğéüĢüúĘħčĜèğüĚħĐèéĕâĄĘĠĆè ÷ĔüĐĕâĕċøħĬĕğĄĚħĐãęĨüģþĐąĜŇĢüúĘħčĜè 1, 6-7, 11 jš|¥˜œ€ §rÓ acetazolamide § AMS ¤ƒÚ•ŠÒšo¨‹ ãüĕ÷ĠĈēĊėûĘĢëň acetazolamide Ģü AMS üĔĨüĄĘøĔĨèĠøŇ 250-1000 mg øŇĐĊĔü ìęħèĠøâøŇĕèâĔüģþøĕĄøĬĕĆĕ ĠĈē ğĐâčĕĆúĕèĊėëĕâĕĆøŇĕèĥ ġ÷ąčŇĊüĢĎîŇĠĈňĊĊėûĘâĕĆúĘħčē÷ĊâĠĈēğĎĄĕēâĔýãüĕ÷úĘħĄĘéĬĕĎüŇĕąĢüúňĐèøĈĕ÷åĚĐ âĕĆĢëň ãüĕ÷ 250 mg úěâ 8-24 ëĔħĊġĄè ġ÷ąāėéĕĆöĕéĕâþĆēĊĔøėâĕĆøĐýčüĐèøŇĐąĕĠĈēâĕĆğâė÷ AMS ĢüâĕĆþĿüğãĕåĆĔĨè âŇĐüĥ ġ÷ąāąĕąĕĄĢëňãüĕ÷üňĐąúĘħčě÷úĘħģ÷ňÿĈ ğĆėħĄĆĔýþĆēúĕü 24-48 ëĔħĊġĄèâŇĐüğ÷ėüúĕèãęĨüúĘħčĜè ĠĈēĆĔýþĆēúĕüøŇĐ ğüĚħĐèéüâĈĔýĈèĄĕąĔèāĚĨüúĘħĆē÷ĔýüĨĬĕúēğĈĠĈňĊ ĠĈēĆĔýþĆēúĕüøŇĐĐĘâ 48 ëĔħĊġĄè1 ĐĘâĊėûĘĎüęħèìęħèĠüēüĬĕġ÷ą US CDC åĚĐ 125 mg úěâ 12 ëĔħĊġĄèġ÷ąğĆėħĄĆĔýþĆēúĕüøĔĨèĠøŇ 48 ëĔħĊġĄèâŇĐüğ÷ėüúĕèãęĨüúĘħčĜè ĠĈēĆĔýþĆēúĕüøŇĐğüĚħĐèĎĕâøňĐèĄĘâĕĆ þĿüãęĨüčĜŇúĘħčĜèĄĕâãęĨüģþĐĘâ éüùęèéě÷čĜèčě÷ãĐèâĕĆþĿüĠĈňĊĢĎňĆĔýþĆēúĕüøŇĐĐĘâğāĘąèčĐèĊĔü5 ìęħèĊėûĘĎĈĔèüĘĨéēĢëňéĬĕüĊüąĕ øħĬĕâĊŇĕĊėûĘĠĆâ 45


•šiš‹¨‰Ò†žoƒ‹˜’olÖ¥˜jӕl‹‹˜™oj•o acetazolamide ¨|Ó¥iҕ˜¨‹‚Óšo ĐĕâĕĆģĄŇāęèþĆēčèåŋãĐèąĕüĘĨúĘħāýģ÷ňýŇĐą ģ÷ňĠâŇ ĐĕâĕĆúĕèĆēýýģĎĈğĊĘąüġĈĎėø (ğëŇü þŌččĕĊēýŇĐą åĊĕĄ÷Ĕü ġĈĎėøøħĬĕ ĎüňĕĄĚ÷ĠĈē flushing) ĐĕâĕĆúĕèĆēýýþĆēčĕú (ğëŇü čĔýčü Ąęüèè âĆēčĔýâĆēčŇĕą ĐŇĐüĠĆè ataxia ëĕ ýĆėğĊöþĈĕąĄĚĐğúňĕĠĈēýĆėğĊöþĕâ âĕĆĆĔýĆčÿė÷þâøė ĠĈēþĊ÷ċĘĆČē) ĐĕâĕĆúĕèÿėĊĎüĔè (ğëŇü photosensitivity, SJS, TEN ĠĈēÿĚħüĈĄāėČ) ĐĕâĕĆúĕèđĐĆŋġĄüĠĈēğĄøĕýĐĈėčĄ (ğëŇü electrolyte imbalance, hyper/hypoglycemia, hypokalemia, hyponatremia, metabolic acidosis) 1 âĕĆĆĔýþĆēúĕü acetazolamide ãöēúňĐèĊŇĕèĐĕéúĬĕĢĎňğâė÷ĐĕâĕĆåĈĚħüģčň ĐĕğéĘąü ĎĆĚĐģĄŇčýĕąúňĐè ìęħè ýĆĆğúĕģ÷ňġ÷ąâĕĆĆĔýþĆēúĕüąĕĎĈĔèĐĕĎĕĆ 1 ğüĚħĐèéĕâ acetazolamide ĄĘĐèåŋþĆēâĐýğþŎü sulfa ÷ĔèüĔĨüéęèåĊĆĎĈĘâğĈĘħąèâĕĆĢëňĢüÿĜňúĘħĄĘþĆēĊĔøėĠāňąĕĢüâĈěŇĄ sulfa ġ÷ąğêāĕēÿĜňúĘħĄĘþĆēĊĔøėĠāňąĕĆěüĠĆè ĐąŇĕèģĆâĦøĕĄāýĊŇĕýĕèĆĕąèĕüâĕĆċęâČĕĎĆĚĐøĬĕĆĕýĕèğĈŇĄ ğčüĐĊŇĕĐĕé ĢëňąĕüĘĨģ÷ňĢüâĆöĘéĬĕğþŎüĠĈēÿĜňþłĊąģĄŇģ÷ňĠāňąĕĠýýĆěüĠĆèğāĆĕēāýâĕĆĠāňãňĕĄâĔüĆēĎĊŇĕè sulfonamide antibiotics ĠĈē non-antibiotics øħĬĕâĊŇĕĆňĐąĈē 10 úĔĨèüĘĨåĊĆú÷ĈĐèĢëňĢüčùĕüúĘħìęħèĄĘåĊĕĄāĆňĐĄĎĕâğâė÷âĕĆĠāňĆěüĠĆè 9

http://en.wikipedia.org/wiki/Acetazolamide

•ipšij•sŸ­•Šš acetazolamide ¥Ó „¡Ó‰š‹™‚‚‹œiš‹™­o’•oŠ™oj•sŸ­•r |}‹piš‹}™­ol‹‹ˆÖ•i|ӏŠ ¤ï•opši…ÍšŠ“uœoŠ™o¨‰Ò‰ƒ‹˜p±š¤|Ÿ• ™­o¬~žoi±š“|¬l‹p˜‰¤Ÿ•|ƒ‹˜p±š¤|Ÿ•¥Ó Šš­’š‰š‹~§rÓ§„¡Ó“uœo}™­ol‹‹ˆÖ ¨|ӓ‹Ÿ•¨‰Ò? Acetazolamide éĔ÷ĐąĜŇĢü pregnancy risk category C ìęħèĄĘÿĈâĕĆċęâČĕĢüčĔøĊŋú÷ĈĐèúĘħĠč÷èćúûėī teratogen ĠøŇąĔèģĄŇāýĆĕąèĕüąĚüąĔüåĊĕĄğþŎüāėČĢüĎîėèøĔĨèåĆĆăŋ ĐąŇĕèģĆâĦøĕĄåĊĆĎĈĘâğĈĘħąèąĕüĘĨĎĕâģĄŇéĬĕğþŎü1 čĬĕĎĆĔýâĆöĘ ċęâČĕüĘĨ ìęħèÿĜňĄĕĆĔýýĆėâĕĆþĆēčèåŋéēĢëňąĕğāĚħĐþŃĐèâĔüâĕĆğâė÷ AMS üĔĨüĎĕâøĆĊé÷ňĊąëě÷øĆĊéøĔĨèåĆĆăŋĠĈňĊģ÷ňÿĈýĊâ åĊĆĆĔýâĕĆøĆĊéąĚüąĔüâĕĆøĔĨèåĆĆăŋĐĘâåĆĔĨè ĠĈēþĆĔýğþĈĘħąüĠÿüâĕĆúŇĐèğúĘħąĊĢĎňğĎĄĕēčĄâĔýčěãăĕāãĐèĎîėèøĔĨèåĆĆăŋ éēğþŎüâĕĆğĎĄĕēčĄâĊŇĕ

pšiiš‹’•‚~š‰~žoƒ‹˜™}œ¥†ÓŠš †‚Òš„¡Ó‰š‹™‚‚‹œiš‹™­o’•o¨‰Ò‰ƒ‹˜™}œ¥†ÓŠš ¥}ҏҚ‰¤†ï•‹Ò‰‰•i lsž¬o‰ƒ‹˜™}œ¥†ÓŠš Bactrim® sž¬o¤lŠ§rÓ §™Š¤|«i ±š§“Ó¤ˆ’™ri‹¤iœ|lš‰¨‰Ò‰¬™§p§iš‹pҚŠŠš acetazolamide ¨ƒ¤„Ÿ¬•¤†Ÿ¬•j•o„¡­‰š‹™‚‚‹œiš‹ ¥˜}­•o†œpš‹{ššo¤Ÿ•i•Ÿ¬•i¤“Ÿ•pši acetazolamide •ipši acetazolamide ¥Ó Š™o‰Šš•ï•i“‹Ÿ•¨‰Ò¬’š‰š‹~§rÓ§ˆš˜ AMS ¨|Ó? ĄĘâĕĆċęâČĕĎĈĕąâĕĆċęâČĕúĘħĠč÷èùęèåĊĕĄğþŎüģþģ÷ňĢüâĕĆĢëňąĕúĕèğĈĚĐâĐĚħüĥ ğāĚħĐþŃĐèâĔüâĕĆğâė÷ AMS Đĕúė dexamethasone ìęħèüĐâéĕâéēĢëňþŃĐèâĔüâĕĆğâė÷ AMS ĠĈňĊąĔèčĕĄĕĆùĢëňþŃĐèâĔüĠĈēĆĔâČĕ HACE ģ÷ň÷ňĊą ĐąŇĕèģĆ âĦøĕĄ dexamethasone üĔĨüģĄŇüėąĄĢëňĢüĊĔøùěþĆēčèåŋğāĚħĐþŃĐèâĔü AMS ĄĕâğúŇĕ HACE úĔĨèüĘĨğüĚħĐèéĕâĐĔüøĆĕąéĕâ ąĕüĔĨüĄĘĄĕââĊŇĕþĆēġąëüŋúĘħĐĕéģ÷ňĆĔý8 čĬĕĎĆĔý nifedipine, tadalafil, sildenafil ĠĈē salmeterol üĔĨüĄĘýúýĕúĢüâĕĆ þŃĐèâĔü HAPE ĠøŇģĄŇāýþĆēġąëüŋĢü AMS 5,10 46


•ipšiiš‹§rӊš¥Ó Š™o‰œ€iš‹§|•i‚Óšo¬‰ƒ‹˜¦ŠrÖ §iš‹ƒÎ•oi™ AMS? âĕĆþŃĐèâĔü AMS úĘħ÷ĘúĘħčě÷åĚĐâĕĆãęĨüčĜŇúĘħčĜèĐąŇĕèëňĕĥ ĠĈēĎĈĘâğĈĘħąèâėé âĆĆĄúĘħøňĐèĐĐâĠĆèĢüëŇĊèĊĔüĠĆâúĘħãęĨüčĜŇúĘħčĜè úĔĨèüĘĨúĘħüĐüãĐèĠøŇĈēåĚüģĄŇåĊĆøŇĕè éĕâåĚüâŇĐüĄĕââĊŇĕ 300 ğĄøĆ âĕĆĢëňĎĈĔââĕĆ “climb-high, sleep-low” ìęħèĎĄĕą ùęèâĕĆĈ÷Ćē÷ĔýåĊĕĄčĜèéĕâúĘħþĿüģ÷ňĢüëŇĊèâĈĕèĊĔüĈèĄĕøĔĨèĠåĄþņüĐüĢüĆē÷Ĕý åĊĕĄčĜèúĘħøħĬĕâĊŇĕ čĕĄĕĆùĈ÷ġĐâĕčğâė÷ AMS Ĉèģ÷ň 5 øĔĊĐąŇĕèâĕĆþĆēąěâøŋĢëňĎĈĔââĕĆ “climb-high, sleep-low” ğëŇü âĕĆúĘüħ âĔ úŇĐèğúĘąħ ĊøĔèĨ ĠåĄþņĢüúĘčħ èĜ øŇĕèâĔüĎĈĕą Ćē÷Ĕý ĢüĊĔüĠĆâþĿüéĕâĠåĄþņĈŇĕèčě÷ãęĨüģþąĔèĠåĄþņùĔ÷ģþ ĠĈēâĈĔýĈèĄĕüĐüĠåĄþņĈŇĕè úĬĕğëŇüüĘĨčĈĔýâĔüĆēąēĎüęħè ġ÷ąåŇĐąĥ ğāėħĄĆēąēğĊĈĕúĘħúĬĕâėéâĆĆĄúĘħĠåĄþņýüĢĎňüĕüãęĨü ğĄĚħĐĆŇĕèâĕąğĆėħĄþĆĔýøĔĊģ÷ňéęèþĿüãęĨüģþąĔèĠåĄþņúĘħčĜèĄĕâ ąėħèãęĨüģþ ĠĈēþĿüĈèĄĕüĐüĠåĄþņĆē÷ĔýúĘħøħĬĕĈèĄĕĎüęħèãĔĨü âĕĆúĬĕğëŇüüĘĨéēëŇĊąĢĎňğâė÷ acclimatization úĘħĄĘþĆēčėúûėăĕā ĠĈēĈ÷ġĐâĕčğâė÷ AMS ģ÷ň ğüĚħĐèéĕâāýĊŇĕâĕĆ÷ĚħĄĠĐĈâĐđĐĈŋĄĘčŇĊüčŇèğčĆėĄĢĎňğâė÷ AMS ģ÷ňĄĕâãęĨü úĔĨèüĘĨĐĕéğþŎüÿĈéĕâĠĐĈâĐđĐĈŋ âĆēøěňüĢĎňğâė÷ăĕĊēãĕ÷üĨĬĕ ĐĘâúĔĨèąĔèãĔ÷ãĊĕèâĆēýĊüâĕĆ acclimatization ÷ĔèüĔĨüéęèåĊĆĎĈĘâğĈĘħąèğåĆĚħĐè÷ĚħĄĠĐĈâĐđĐĈŋ úěâëüė÷ ġ÷ąğêāĕēĢüĆēąē 24 ëĔħĊġĄèĠĆâğĄĚħĐãęĨüģþùęèúĘħčĜè âĕĆ÷ĚħĄüĨĬĕþĆėĄĕöğāĘąèāĐĐĕéëŇĊąĈ÷ġĐâĕčğâė÷ AMS Ĉè ģ÷ň ĠøŇøňĐèĆēĊĔèģĄŇĢĎňģ÷ňĆĔýþĆėĄĕöĄĕâğâėüģþ ğüĚħĐèéĕâĐĕéúĬĕĢĎňğâė÷ĐĔüøĆĕąéĕâ hyponatremia ģ÷ň 3 âĕĆĢëňąĕüĐüĎĈĔýğāĚħĐýĆĆğúĕĐĕâĕĆüĐüģĄŇĎĈĔýĢü AMS ğþŎüčėħèúĘħåĊĆĎĈĘâğĈĘħąèúĔĨèüĘĨğüĚħĐèéĕââĆēýĊüâĕĆ čĬĕåĔîãĐè acclimatization åĚĐâĕĆğāėħĄĐĔøĆĕâĕĆĎĕąĢé ğāĚħĐĆĔýĐĐâìėğéüĢĎňğāĘąèāĐĠâŇåĊĕĄøňĐèâĕĆãĐèĆŇĕèâĕą ìęħè âĆēýĊüâĕĆ÷ĔèâĈŇĕĊüĘĨĐĕéùĜâąĔýąĔĨèĎĆĚĐãĔ÷ãĊĕèġ÷ąąĕüĐüĎĈĔýģ÷ň 3 •ˆœƒ‹šŠ¥˜’‹ ƒi‹{ži‘š AMS ğþŎüăĕĊēĐĔüøĆĕąúĘāħ ýģ÷ňĢüüĔâúŇĐèğúĘąħ ĊúĘĄħ éĘ ÷ě ĄěèŇ ĎĄĕąğþŎüăĜğãĕčĜèĢüøŇĕèþĆēğúċĆĊĄùęèÿĜúň ĆħĘ âĔ ĢüâėéâĆĆĄ þĿüğãĕ åĊĕĄøĆēĎüĔâùęèĐĔüøĆĕąãĐè AMS čĆňĕèåĊĕĄâĔèĊĈĢĎňĠâŇüĔâúŇĐèğúĘħąĊĎĈĕąĆĕąéüøňĐèğãňĕĄĕãĐĆĔýåĬĕ þĆęâČĕéĕâğăčĔëâĆëěĄëü ÷ĔèüĔĨüğăčĔëâĆëěĄëüéęèĄĘýúýĕúĢüâĕĆĢĎňåĬĕĠüēüĬĕâĕĆþñėýĔøėøüğāĚħĐþŃĐèâĔü AMS ĐĘâ úĔĨèāėéĕĆöĕéŇĕąąĕ acetazolamide ÷ňĊąãňĐýŇèĢëňĢüâĕĆþŃĐèâĔüâĕĆğâė÷ăĕĊēĐĔüøĆĕą÷ĔèâĈŇĕĊ ìęħèéēğþŎüĐĘâġĐâĕč ĎüęħèĢüâĕĆĠč÷èýúýĕúĊėëĕëĘāĢüâĕĆğāėħĄåěöăĕāëĘĊėøãĐèþĆēëĕëüĠĄňéēąĔèģĄŇĄĘġĆåăĔąģãňğéĦý ğăčĔëâĆâĦĄĘčŇĊüëŇĊą ĢĎňâĕĆúŇĐèğúĘħąĊĄĘåĊĕĄčüěâ þĈĐ÷ăĔą ģĆňåĊĕĄâĔèĊĈ ğĐâčĕĆĐňĕèĐėè 1. Lacy CF, Armstrong LL, Goldman MP, Lance LL, (editors). Drug information handbook 2010-2011. 19th ed. Ohio: Lexi-Comp; 2010. 2. Hacket PH, Roach RC. High-altitude illness. N Engl J Med 2001; 345(2): 107-14. 3. Fiore DC, Hall S, Shoja P. Altitude illness: risk factors, prevention, presentation, and treatment. Am Fam Physician 2010; 82(9): 1103-10. 4. Kilner T, Mukerji S. Acute mountain sickness prophylaxis: knowledge, attitudes, & behaviours in the Everest region of Nepal. Travel Med Infect Dis 2010; 8(6): 395-400. 5. Luks AM, Swenson ER. Medication and dosage considerations in the prophylaxis and treatment of high-altitude illness. Chest 2008; 133: 744-55. 6. Hohne C, Krebs MO, Seiferheld M, et al. Acetazolamide prevents hypoxic pulmonary vasoconstriction in conscious dogs. J Appl Physiol 2004; 97: 515–521.

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º·¤ÇÒÁ CPE

ăî.ÿċ.üėøąĕĊĆĆö âěĈöĕĊĆĆö åöēğăčĔëċĕčøĆŋ Ą.ĎĔĊğêĘąĊğêĈėĄāĆēğâĘąĆøė

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‰˜¤‹«o‹ ҁ§“‰Ò

: Targeted agents

ĊĔøùěþĆēčèåŋ : ğĄĚħĐċęâČĕýúåĊĕĄĠĈňĊÿĜňğĆĘąüčĕĄĕĆùĐûėýĕąåĊĕĄĆĜň÷ĔèøŇĐģþüĘĨ 1. âĕĆğâė÷ğìĈĈŋĄēğĆĦè 2. ëĘĊĊėúąĕãĐèğìĈĈŋĄēğĆĦè 3. ĐĕâĕĆģĄŇāęèþĆēčèåŋãĐèğåĄĘýĬĕýĔ÷ 4. âĈģââĕĆĐĐâćúûėīãĐèąĕøňĕüĄēğĆĦè targeted agents 5. ãňĐĄĜĈãĐèčĕĆčâĔ÷éĕâāĚëøŇĐğìĈĈŋĄēğĆĦè ğìĈĈŋĄēğĆĦèåĚĐğìĈĈŋúĘħğâė÷éĕâğìĈĈŋþâøėúĘħĄĘąĘüâĈĕąāĔüûěŋ ğĄĚħĐâĕĆâĈĕąāĔüûěŋĄĘāĔõüĕâĕĆğøĦĄúĘħ ğìĈĈŋéēčĜîğčĘą ĎüňĕúĘħ ģĄŇčĕĄĕĆùåĊýåěĄâĕĆğéĆėîĠĈēĠýŇèøĔĊ øĈĐ÷éüģĄŇčĕĄĕĆùåĊýåěĄâĕĆøĕąãĐèğìĈĈŋøĕĄûĆĆĄëĕøė (apoptosis) úĬĕĢĎňğâė÷âňĐüğüĚĨĐġøãęĨü âĕĆâĈĕąāĔüûŋěãĐèąĘüĢü DNA ğâė÷éĕâąĘüģ÷ňĆĔýĐĔüøĆĕąéĕâúĔĨèþŌééĔąăĕąüĐâ ğëŇü ĆĔèčĘ ģĊĆĔč ĠýåúĘğĆĘą ġþĆġøìĔĊ ąĕøňĕüĄēğĆĦè čĕĆğåĄĘ ĠĈēéĕâþŌééĔąăĕąĢü ğëŇü čĕĆĐüěĄĜĈĐėčĆēúĘħğâė÷éĕââĆēýĊüâĕĆğĄøĕýĐ ĈėìęĄ þĆēâĐýâĔýåĊĕĄýâāĆŇĐèúĕèāĔüûěâĆĆĄúĘħğâĘħąĊãňĐèâĔýâĆēýĊüâĕĆìŇĐĄĠìĄ DNA úĘħùĜâúĬĕĈĕą üĐâéĕâüĘĨğìĈĈŋ ĄēğĆĦèąĔèčĕĄĕĆùâĆēøěňüâĕĆčĆňĕèĎĈĐ÷ğĈĚĐ÷ĢĎĄŇğāĚħĐğþŎüğčňüúĕèĈĬĕğĈĘąèĐĕĎĕĆĠĈēĐĐâìėğéüĢĎňĠâŇğüĚĨĐğąĚħĐĄēğĆĦèúĘħ ğéĆėîĢĎĄŇĠĈēğìĈĈŋĄēğĆĦèčĕĄĕĆùčĆňĕèčĕĆúĘħčŇèğčĆėĄâĕĆĠāĆŇâĆēéĕąéĕâøĬĕĠĎüŇèĠĆâ ġ÷ąğìĈĈŋĄēğĆĦèĎĈě÷ğãňĕģþĢü ĎĈĐ÷ğĈĚĐ÷ĠĈēúŇĐüĨĕĬ ğĎĈĚĐèģþąĔèğüĚĐĨ ğąĚĐħ ĐĚüħ ĥ úĘÿħ Ċė ğìĈĈŋĄøĘ ĊĔ ĆĔýúĘğħ ĎĄĕēčĄøŇĐâĕĆąę÷ğâĕēãĐèğìĈĈŋĠĈēâĕĆğéĆėîãĐè ğìĈĈŋĄēğĆĦè éĕâüĔüĨ ğìĈĈŋĄēğĆĦèâĦğøėýġøĠýŇèğìĈĈŋğéĆėîğþŎüğüĚĐĨ ğąĚĐħ ĄēğĆĦèøĬĕĠĎüŇèúĘčħ ĐèøŇĐģþ (÷ĜĆþĜ úĘħ 1) ĄēğĆĦèčĕĄĕĆù ğâė÷âĔýğüĚĨĐğąĚħĐãĐèúěâĐĊĔąĊēĠĈēúěâĊĔą ĐĔøĆĕåĊĕĄëěâãĐèġĆåĠøâøŇĕèøĕĄğāċ ĊĔą ĠĈēâĆĆĄāĔüûěŋ ġĆåĄēğĆĦèĎĈĕą ëüė÷ĎĕâøĆĊéāýĢüĆēąēøňüĠĈēĆĘýĆĔâČĕĄĘġĐâĕčĎĕąéĕâġĆåģ÷ň ĎĈĔââĕĆĆĔâČĕĄēğĆĦèåĚĐ øňĐèâĬĕéĔ÷ğìĈĈŋĄēğĆĦèìęħè ĐĕéĆĔâČĕġ÷ąâĕĆÿŇĕøĔ÷ âĕĆêĕąĆĔèčĘ âĕĆĆĔâČĕ÷ňĊąąĕøňĕüĄēğĆĦè ĠĈēýĕèâĆöĘøňĐèĢëňĎĈĕąĊėûĘĆŇĊĄâĔü ąĕøňĕüĄēğĆĦèğþŎüčĕĆāėČúĬĕĈĕąğìĈĈŋĄēğĆĦèĠĈēğìĈĈŋþâøėġ÷ąğêāĕēğìĈĈŋúĄħĘ ûĘ ĆĆĄëĕøėâĕĆĠýŇèøĔĊğĆĦĊ ğëŇü ğìĈĈŋ ģãâĆē÷Ĝâ ģãŇ čğþľĆŋĄ ĒĈĒ âĕĆĢëňąĕøňĕüĄēğĆĦèĄĘãňĐéĬĕâĔ÷ĢüğĆĚħĐèāėČãĐèąĕ ĠĈēâĕĆ÷ĚĨĐąĕ ąĕøňĕü ĄēğĆĦèúĔĨèĎĈĕąĄĘþĆēčėúûėăĕāĢüâĕĆĆĔâČĕãęĨüĐąĜŇâĔýãüĕ÷ãĐèąĕ ğüĚħĐèéĕâĐĕâĕĆþĆėĄĕöąĕğāĚħĐ ĆĔâČĕĢâĈňğåĘąèâĔüâĔýþĆėĄĕöąĕĢüâĕĆğâė÷āėČ éęèúĬĕĢĎňĄĐĘ ĕâĕĆģĄŇāèę þĆēčèåŋ ýĕèåĆĔèĨ ĐĕâĕĆģĄŇāèę þĆēčèåŋ ĐĕéåěâåĕĄâĕĆğčĘąëĘĊėø ğëŇü â÷ģãâĆē÷ĜâĆěüĠĆè ĎĆĚĐğþŎüāėČøŇĐĐĊĔąĊēčĬĕåĔî ğëŇü ĎĔĊĢé þĐ÷ ģø ÷ĔèüĔĨüĢüâĕĆĆĔâČĕ÷ňĊąąĕøňĕüĄēğĆĦèéęèĢëňąĕþŃĐèâĔüĐĕâĕĆģĄŇāęèþĆēčèåŋĆŇĊĄ÷ňĊą ąĕøňĕüĄēğĆĦèĆěüŇ ĢĎĄŇé÷Ĕ ğþŎü targeted agents úĘĄħ ćĘ úûėéī ĕĬ ğāĕēøŇĐġþĆøĘüúĘÿħ ÷ė þâøėĢüâĆēýĊü âĕĆğéĆėîãĐèğìĈĈŋĄēğĆĦè ąĕéęèĄěŇèúĬĕĈĕąğìĈĈŋĄēğĆĦèğþŎüĎĈĔâ éęèģĄŇåŇĐąĄĘÿĈâĆēúýøŇĐâĕĆğéĆėî ãĐèğìĈĈŋþâøėüĔâ ĢëňëŇĊąğčĆėĄâĕĆĆĔâČĕãĐèąĕøňĕüĄēğĆĦèĆěŇüĠĆâĢĎňÿĈâĕĆĆĔâČĕ÷ĘąėħèãęĨü 48


iš‹išŠ†™€ Öj•oŠ Proto-oncogene à»ÅÕè¹໚¹ oncogene ઋ¹ Sis, erbB, ras, cyclin D

Å´¡Ò÷íÒ§Ò¹¢Í§ tumor suppressor gene ઋ¹ p53, Rb áÅÐÍ×è¹æ

¤Çº¤ØÁ¡ÒÃà¨ÃÔÞáÅÐ˹ŒÒ·ÕèäÁ‹ä´Œ

Å´ apoptosis áÅÐÊÌҧ telomerase

à¡Ô´ÁÐàÃ秷Õè‡íÒá˹‹§áá ÊÌҧÊÒÃá¾Ã‹¡ÃШÒ ઋ¹ matrix metalloproteinase á·Ã¡¡ÃШÒÂࢌÒà¹×éÍàÂ×èÍã¡ÅŒà¤Õ§ ÊÌҧËÅÍ´àÅ×Í´ãËÁ‹à¾×èÍËÅ‹ÍàÅÕé§à¹×éÍàÂ×èÍÁÐàÃç§ á¾Ã‹à¢ŒÒËÅÍ´àÅ×Í´/·‹Í¹éíÒàËÅ×ͧÁÐàÃç§ à¡Ô´à¹×éÍàÂ×èÍÁÐàÃ秷ÕèÍÇÑÂÇÐÍ×è¹ ĆĜþúĘħ 1 ĠÿüăĜĄėâĕĆāĔõüĕâĕĆâĕĆğâė÷ĄēğĆĦè

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r¦‰¤i ¬¤iœ|pšiiš‹išŠ†™€ Öj•oŠ1, 2

÷ňĊąåĊĕĄâňĕĊĎüňĕúĕèāĔüûěâĆĆĄċĕčøĆŋ (genomics) ğþŎüúĘúħ ĆĕýĠüŇë÷Ĕ ĊŇĕğìĈĈŋĄēğĆĦèğâė÷éĕââĕĆâĈĕąāĔüûěãŋ Đè protooncogenes ĠĈē tumor suppressor genes ĠĈēúĆĕýĊŇĕĢüğìĈĈŋĄēğĆĦèĠøŇĈēëüė÷ĄĘąĘüĢ÷ýňĕèâĈĕąāĔüûěŋ úĬĕĢĎňĄĘ ëĘĊġĄğĈâěĈĢ÷ĄĘĎüňĕúĘħÿė÷þâøė ëĘĊġĄğĈâěĈúĘħğâė÷éĕâąĘüúĘħâĈĕąāĔüûěŋğĎĈŇĕüĘĨéęèùĜââĬĕĎü÷ğþŎüğþŃĕĎĄĕąĢüâĕĆĐĐâćúûėī ãĐèąĕøňĕüĄēğĆĦèğāĚħĐĎąě÷âĕĆğéĆėîãĐèğìĈĈŋ Ĉ÷âĕĆĠāĆŇğìĈĈŋĄēğĆĦè ğĆŇèâĕĆøĕąãĐèğìĈĈŋ ąĕøňĕüĄēğĆĦèĆěŇüĢĎĄŇéęèĄĘ åĊĕĄéĬĕğāĕēøŇĐġþĆøĘüĎĆĚĐğĐüģìĄŋúĘħÿė÷þâøėãĐèğìĈĈŋĄēğĆĦèąėħèãęĨü üĬĕģþčĜŇâĕĆĆĔâČĕĐąŇĕèøĆèğþŃĕĎĄĕą (targeted therapy) øĔĊĐąŇĕèãĐèâĕĆğčĘąčĄ÷ěĈãĐèëĘĊġĄğĈâěĈĎĆĚĐąĘüúĘħÿė÷þâøėĠĈēāýĊŇĕĄĘåĊĕĄčĔĄāĔüûŋâĔýĄēğĆĦèģ÷ňâĈĕąğþŎü ğþŃĕĎĄĕąãĐèâĕĆĐĐâćúûėīãĐèąĕøňĕüĄēĆĦèĆěŇüĎĈĔè ģ÷ňĠâŇ âĕĆâĈĕąāĔüûěŋãĐèąĘüúĘħúĬĕĎüňĕúĘħčŇèğčĆėĄâĕĆğéĆėîãĐèğìĈĈŋ ğëŇü EGFR (ErbB-1), Her 2/neu (ErbB-2), Her 3 (ErbB-3), Her 4 (ErbB-4) âĕĆâĈĕąāĔüûěŋãĐèąĘüüĘĨúĬĕĢĎňĄĘ EGFR (ErbB-1, her-1) úĘħčŇĊü tyrosine kinase âĆēøěňüøüğĐèøĈĐ÷ğĊĈĕāýĢü ĄēğĆĦèþĐ÷ ĄēğĆĦèĈĬĕģčň ąĕúĘħĄĘćúûėīąĔýąĔĨè EGFR ğëŇü gefitinib, irotinib, cetuximab ĢüġĆåĄēğĆĦèğøňĕüĄāýĊŇĕĄĘâĕĆâĈĕąāĔüûěŋ erbB gene úĬĕèĕüĄĕâãęĨü øĆĊéāý Her2 ĄĕââĊŇĕþâøė ąĕúĘħĐĐâ ćúûėīąĔýąĔĨèâĕĆúĬĕèĕüãĐè Her2 åĚĐ trastuzumab âĕĆâĈĕąāĔüûěŋ c-sis gene éēāý PDGF receptor ğāėħĄãęĨüĢüÿĜňþłĊąġĆå chronic myeloid leukemia ąĕúĘħĐĐâ ćúûėīøňĕü PDGF receptor åĚĐ imatinib ġĆåĄēğĆĦèĄĕââĊŇĕĆňĐąĈē 30 ëüė÷ĢüĄüěČąŋāýĊŇĕĄĘâĕĆâĈĕąāĔüûěŋ RAS gene RAS ğþŎüġþĆøĘüúĘħğâĕēĐąĜŇúĘħÿėĊ ÷ňĕüĢüãĐèğąĚħĐĎěňĄğìĈĈŋ ĄĘåĊĕĄčĬĕåĔîĢüâĕĆâĆēøěňü cytoplamic kinase ĈĬĕ÷ĔýĐĚħüĥ ĢüĊėùĘãĐèâĕĆâĆēøěňüąĘüúĘħčŇè ğčĆėĄâĕĆğéĆėîãĐèğìĈĈŋ âĕĆâĈĕąāĔüûěŋãĐè Abl gene ìęħèğþŎüąĘüúĘħùĐ÷ĆĎĔčâĕĆčĆňĕè abl tyrosine kinase Ģü cytoplasm åĊĕĄÿė÷þâøė üĘĨāýĢüÿĜňþłĊą chronic myeloid leukemia ąĕ imatinib čĕĄĕĆùąĔýąĔĨè abl tyrosine kinase âĕĆâĈĕąāĔüûěŋãĐè Jun, Fos, Myc âĕĆâĈĕąāĔüûěŋãĐèąĘüğĎĈŇĕüĘĨāýĢüġĆåĄēğĆĦèĈĬĕģčňĢĎîŇ ĄēğĆĦèþĐ÷ ĄēğĆĦè čĄĐè âĕĆâĈĕąāĔüûěŋãĐè RB gene āýģ÷ňùęè 30- 40% ãĐèġĆåĄēğĆĦèĢüĄüěČąŋ

i ҉Šš¬••iŒ€œ°}ҕ¦‰¤i ¤ƒÎš“‰šŠj•o¤sÖ‰˜¤‹«o•ŠÒšop±š¤†š˜ (targeted agents) ąĕĐĐâćúûėøī ĐŇ ġĄğĈâěĈğþŃĕĎĄĕąĢüğìĈĈŋĄēğĆĦèĐąŇĕèéĬĕğāĕēğéĕēéè ąĕ âĈěĄŇ üĘéĨ ÷Ĕ ğþŎüąĕĢĎĄŇĆĕåĕĠāèĄĕâ åĊĆğĈĚĐâĢëňğĄĚĐħ ğìĈĈŋĄēğĆĦè÷ĚĐĨ øŇĐąĕøĔĊĐĚüħ ąĕ úĬĕĢĎňğâė÷ĐĕâĕĆģĄŇāèę þĆēčèåŋüĐň ąâĊŇĕąĕâĈěĄŇ ĠĆâĥ úĘâħ ĈŇĕĊĄĕĠĈňĊ øĔĊĐąŇĕè ãĐèąĕâĈěŇĄüĘĨģ÷ňĠâŇ 1. i Ò‰ monoclonal antibody ąĕâĈěŇĄüĘĨĄĘĈĔâČöēúĕèğåĄĘğþŎü monoclonal antibody čĕĄĕĆùéĔý âĔýġþĆøĘüúĘħÿėĊãĐèğìĈĈŋ ĎĆĚĐġþĆøĘüúĘħčĆňĕèéĕâğìĈĈŋĄēğĆĦèĐąŇĕèéĬĕğāĕēğéĕēéè øĔĊĐąŇĕèąĕģ÷ňĠâŇ

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1.1 Rituximab ğþŎü monoclonal antibody ìęħèéēéĔýâĔýġþĆøĘü CD20 ýüğìĈĈŋĄēğĆĦè B cell ĠĈēúĬĕĈĕą ğìĈĈŋĢüúĘħčě÷ ĢüÿĜňþłĊą chronic lymphocytic leukemia (CLL) ĎĈĔèéĕâģ÷ňĆĔýąĕ rituximab øĆĊéāýĊŇĕĄĘ activated caspase - 9, casepase-3, ĠĈē poly (ADP-ribose) polymerase (PARP) ĢüğĈĚĐ÷ ìęħèğĐüģìĄŋğĎĈŇĕüĘĨğþŎüğĐüģìĄŋĢü âĆēýĊüâĕĆğâė÷ apoptosis ãĐèğìĈĈŋĄēğĆĦèğĄĦ÷ğĈĚĐ÷ãĕĊ3 ĄĘþĆēġąëüŋĢëňĆĔâČĕ non-Hodgkin lymphoma ĠĈē CLL ġ÷ąĢëňĆŇĊĄâĔýąĕøňĕüĄēğĆĦèãüĕüĐĚħüĥ ĐĕâĕĆģĄŇāęèþĆēčèåŋúĘħāýýŇĐąåĚĐ åĊĕĄ÷ĔüġĈĎėøčĜè ĎüĕĊčĔħü ġ÷ąğêāĕēëŇĊè ĠĆâãĐèâĕĆģ÷ňĆĔýąĕ ĢüĆēąēĎĈĔèĥ Đĕéğâė÷ cytokine release reaction ĠĈēĄĘāėČøŇĐĎĔĊĢé

ĆĜþúĘħ 2 âĕĆĐĐâćúûėīãĐè Rituximab

1.2 Trastuzumab ğþŎü humanized murine monolclonal antibodies éēéĔýâĔýġþĆøĘü Her2/neu (ĎĆĚĐ ğĆĘąâĊŇĕ HER2) ġþĆøĘüëüė÷üĘĨéĔ÷ĐąĜŇĢüâĈěŇĄ epidermal growth factor receptor čŇèÿĈĢĎňĈ÷âĕĆüĬĕčŇèčĔîîĕöâĆēøěňü âĕĆğéĆėîãĐèğìĈĈŋ úĬĕĢĎňąĔýąĔĨèĊèéĆëĘĊėøãĐèğìĈĈŋĄēğĆĦè ÿĜňþłĊąĄēğĆĦèğøňĕüĄĄĘþĆėĄĕö HER2 ĄĕââĊŇĕþâøėğìĈĈŋéē ĠýŇèøĔĊğĆĦĊĄĕâ4

ĆĜþúĘħ 3 âĕĆĐĐâćúûėīãĐè Trastuzumab

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1.3 Alemtuzumab ğþŎü humanized monoclonal antibody ĐĐâćúûėīéĔýâĔý CD52 ýüÿėĊãĐè B cell Ģëň ĆĔâČĕ B cell chronic lymphocytic leukemia úĘħĆĔâČĕ÷ňĊąąĕâĈěŇĄ alkylating agents ĎĆĚĐ fludarabine ģĄŇģ÷ňÿĈ5

ĆĜþúĘħ 4 âĈģââĕĆĐĐâćúûėīãĐè Alemtuzumab

ĆĜþúĘħ 5 Humanised monoclonal antibody (ĆēĎĊŇĕèĎüĜĠĈēĄüěČąŋ)

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1.4 Bevacizumab ğþŎü humanized monoclonal antibody ĐĐâćúûėīéĔýâĔý vascular endothelial growth factor (VEGF) þŃĐèâĔüĄėĢĎň VEGF éĔýâĔýøĔĊĆĔýýüÿėĊãĐèğìĈĈŋĎĈĐ÷ğĈĚĐ÷ þŃĐèâĔüâĕĆčĆňĕèĎĈĐ÷ğĈĚĐ÷ĢĎĄŇ ĠĈēúĬĕĢĎňĎĈĐ÷ğĈĚĐ÷ĢüğüĚĨĐğąĚħĐĄēğĆĦèčĈĕąøĔĊ ąĕüĘĨéĔ÷ğþŎüąĕ anti-angiogenetic agent øĔĊĠĆâĠĈēģ÷ňĆĔýĐüěĄĔøėéĕâ čĬĕüĔâèĕüĐĕĎĕĆĠĈēąĕĠĎŇèčĎĆĔòĐğĄĆėâĕĢĎňĢëňğþŎüąĕĐĔü÷ĔýĠĆâġ÷ąĢëňĆŇĊĄâĔý 5-FU ğāĚħĐĆĔâČĕĄēğĆĦèĈĬĕģčňĢĎîŇĆēąē ĠāĆŇâĆēéĕą6 1.5 Cetuximab ĐĐâćúûėīþľ÷âĔĨü epidermal growth factor receptor (EGFR) ĄėĢĎňùĜââĆēøěňü÷ňĊąčĕĆ âĆēøěňüâĕĆğéĆėî (EPGF) EGFR éęèģĄŇčĕĄĕĆùğĎüĘħąĊüĬĕĢĎňğĐüģìĄŋ kinase ĢüģìġøìĐĈĢĎňúĬĕèĕüģ÷ň âĆēýĊüâĕĆ øŇĕèĥ ĢüğìĈĈŋúĘħĐĕċĔą kinase éęèģĄŇúĬĕèĕü éęèúĬĕĢĎňğìĈĈŋģĄŇğéĆėî øĕąğĆĦĊãęĨü ğìĈĈŋĄēğĆĦèĈ÷âĕĆčĆňĕè VEGF úĬĕĢĎňĈ÷ âĕĆčĆňĕèĎĈĐ÷ğĈĚĐ÷ĢĎĄŇĢüğüĚĨĐğąĚħĐĄēğĆĦè Ĉ÷âĕĆčĆňĕè metrix metallo-proteinase éęèĈ÷âĕĆĠāĆŇâĆēéĕąğìĈĈŋĄēğĆĦè ĢëňĆĔâČĕĄēğĆĦèĈĬĕģčňĢĎîŇĆēąēĈěâĈĕĄúĘħøĆĊéāý EGFR ġ÷ąĢëňĆŇĊĄâĔýąĕ irinotecan ĠĈē 5-FU ĎĆĚĐĢëňğ÷ĘħąĊĥ ğāĚħĐ ĆĔâČĕĄēğĆĦèåĐĠĈēċĘĆČēúĘħĈěâĈĕĄĠĈēĢëňąĕâĈěŇĄĠāĈøėüĔħĄĠĈňĊģĄŇģ÷ňÿĈ7 2. Indium-111 or Yttrium-90 radiolabled Ibritumomab Tiuxetan8 ģ÷ňĆĔýĐüěĄĔøėéĕâ FDA ãĐèčĎĆĔòĐğĄĆėâĕĢüğ÷ĚĐüĄĘüĕåĄ 2002 ğþŎüąĕøĔĊĠĆâúĘħĄĘčŇĊüþĆēâĐýčĕĄëüė÷åĚĐ monclonal antibody (ibritumomab), thiourea ĠĈēčĕĆâĔĄĄĔüøăĕāĆĔèčĘ ĢëňĆĔâČĕ transformed B-cell non Hodgkin’s lymphoma úĘħ÷ĚĨĐøŇĐąĕ rituximab 3. Tyrosine kinase inhibitors 3.1 Gefitimib ĠĈē irotinib ąĕúĔĨèčĐèĄĘâĈģââĕĆĐĐâćúûėīåĈňĕąåĈęèâĔü åĚĐ ąĔýąĔĨè phosphorylation ãĐè tyrosine kinase domain ãĐè HER1 ìęħèğþŎü epidermal growth factor receptor (EGFR) ëüė÷Ďüęħè ĠĈēčĕĄĕĆù ąĔýąĔĨèğĐüģìĄŋ kinase ĢüģìġøìĐĈģ÷ň÷ňĊą úĬĕĢĎňğìĈĈŋģĄŇğéĆėî Ĉ÷âĕĆĠāĆŇâĆēéĕą Ĉ÷âĕĆčĆňĕèĎĈĐ÷ğĈĚĐ÷ĢĎĄŇ ğĆŇèĢĎň ğìĈĈŋøĕą âĕĆâĈĕąāĔüûěŋąĘü EGFR ĢüğìĈĈŋĄēğĆĦèéēāýĊŇĕĄĘ EGFR ëüė÷üĘĨĄĕâ ğëŇü non small cell lung cancer9,10

ĆĜþúĘħ 6 âĈģââĕĆĐĐâćúûėīãĐè gefitinib

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3.2 Imatinib mesylate ğþŎüąĕąĔýąĔĨèâĕĆğĎüĘħąĊüĬĕčĔîîĕöĢüĆēýý kinase receptor ãĐè platelet derived growth factor ĠĈēąĔýąĔĨèĆēýý cytoplasmic kinase (ğëŇü Bcr/Abl kinase) ìęħèğþŎüğĐüģìĄŋčĬĕåĔîúĘħúĬĕĢĎň ğìĈĈŋğéĆėîĠĈēąĔýąĔĨè apotosis ąĕüĘĨĢëňĆĔâČĕĄēğĆĦè chronic myeloid leukemia úĘħøĆĊéāýĊŇĕĄĘ Bcr/Abl kinase éĬĕüĊüĄĕâ11

ĆĜþúĘħ 7 âĈģââĕĆĐĐâćúûėīãĐè Imatinib

4. Proteasome inhibitor12 ąĕ bortezomib ĐĐâćúûėīąĔýąĔĨè proteasome ąĔèÿĈĢĎňğìĈĈŋĎąě÷âĕĆğéĆėî ğāĆĕē proteasome ğþŎüğĐüģìĄŋ úĘħąŇĐąġþĆøĘüúĘħåĊýåěĄ nuclear factor regulator ĢĎňĎĈě÷ĐĐâéĕâ nuclear factor regulator úĬĕĢĎň active nuclear factor regulator čĕĄĕĆùģþâĆēøěňüąĘüĢĎňúĬĕĎüňĕúĘħùĐ÷ĆĎĔčâĕĆčĆňĕèčĕĆúĘħğĆŇèâĕĆğéĆėîĠĈēčĕĆąĔýąĔĨè apoptosis ãĐè ğìĈĈŋ

’‹ ƒ

ąĕøňĕüĄēğĆĦèĆěŇüĠĆâĥ ĄěŇèúĬĕĈĕąğìĈĈŋĄēğĆĦè ĠĈēčŇĊüĄĕââĆēúĬĕøŇĐ DNA ÷ĔèüĔĨüéęèĄĘÿĈâĆēúýøŇĐğìĈĈŋþâøė ÷ňĊąĠĈēĐĕéúĬĕĢĎňğìĈĈŋþâøėâĈĕąāĔüûěŋğþŎüĄēğĆĦèģ÷ň ğìĈĈŋþâøėúĘħĄĘûĆĆĄëĕøėâĕĆğéĆėîĠĈēĠýŇèøĔĊģĊéēùĜâúĬĕĈĕąģ÷ňģĊ ğëŇü ğìĈĈŋøňüâĬĕğüė÷ğĄĦ÷ğĈĚĐ÷ ģãŇ čğþľĆŋĄ ğąĚħĐýěëŇĐèþĕâ ĐĕâĕĆãňĕèğåĘąèĠĈēāėČãĐèąĕĆěŇüĠĆâéęèĄĘāėČøŇĐğìĈĈŋþâøė åŇĐüãňĕèëĔ÷ğéü ĐĕâĕĆúĘħāýýŇĐą ğëŇü â÷âĕĆčĆňĕèģãâĆē÷Ĝâ ġ÷ąğêāĕēâĕĆâ÷âĕĆčĆňĕèğĄĦ÷ğĈĚĐ÷ãĕĊĠĈēăĜĄėøňĕüúĕü Ĉ÷ĈèúĬĕĢĎňøė÷ğëĚĨĐģ÷ňèŇĕą ÿĄĆŇĊè ĠÿĈĎĕąëňĕ ğþŎüĎĄĔü úĕĆâĢüåĆĆăŋāėâĕĆ ğþŎüĠÿĈĢüþĕâ ąĕøňĕüĄēğĆĦèýĕèëüė÷ âĆēøěňüâĕĆåĈĚħüģčňĐĕğéĘąüĆěüĠĆèĄĕâ čĕĆĠþĆĆĜþãĐèąĕýĕèëüė÷ĄĘāėČ ąĕýĕèëüė÷ğĄĚħĐĢëňĢüãüĕ÷čĜèĥ ğâė÷āėČøŇĐ ĐĊĔąĊēčĬĕåĬî ğëŇü āėČøŇĐģø āėČøŇĐøĔý āėČøŇĐĎĔĊĢé āėČøŇĐþĐ÷ åĊĕĄĆěüĠĆèãĐèĐĕâĕĆģĄŇāęèþĆēčèåŋĐĕéğâė÷Ąĕâ üňĐąøŇĕèâĔüãęĨüĐąĜŇâĔýåěöčĄýĔøėğêāĕēãĐèąĕĠøŇĈēøĔĊĠĈēãüĕ÷ąĕúĘħĢĎňâĔýÿĜňþłĊą

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ĆĜþúĘħ 8 čĆěþĐĕâĕĆģĄŇāęèþĆēčèåŋãĐèąĕğåĄĘýĬĕýĔ÷

ąĕøňĕüĄēğĆĦèĆěŇüĢĎĄŇúĘħéĔ÷ğþŎü targeted agents ĐĐâćúûėīøŇĐġĄğĈâěĈğþŃĕĎĄĕąúĘħğþŎüĈĔâČöēğêāĕēãĐèğìĈĈŋ ĄēğĆĦèĠøŇĈēëüė÷ ąĕâĈěŇĄüĘĨéęèĄĘÿĈøŇĐğìĈĈŋþâøėüňĐąâĊŇĕğĄĚħĐğþĆĘąýğúĘąýâĔýąĕĆěŇüĠĆâĥ ĠøŇąĔèøňĐèğĀŃĕĆēĊĔèĐĕâĕĆģĄŇ āęèþĆēčèåŋĐĚħüĥ ğāĆĕēğþŎüąĕĢĎĄŇĐĘâúĔĨèĆĕåĕĠāèĄĕâ ĠĈēÿĈâĕĆĆĔâČĕġĆåģĄŇĎĕąãĕ÷ğāĘąèëēĈĐâĕĆâĬĕğĆėýãĐèġĆå ğúŇĕüĔĨü éęèâĬĕĎü÷ĢĎňğĈĚĐâĢëňąĕĆěŇüĢĎĄŇĎĈĔèéĕââĕĆĆĔâČĕ÷ňĊąąĕĆěŇüĠĆâģĄŇģ÷ňÿĈ ĠĈēĢüâĕĆĆĔâČĕĄēğĆĦèýĕèëüė÷âĦąĔè åèøňĐèĢëňĆŇĊĄâĔýąĕĆěŇüĠĆâğāĚħĐğāėħĄþĆēčėúûėăĕāãĐèąĕĆěŇüĠĆâ ĐěýĔøėâĕĆöŋâĕĆğâė÷ġĆåĄēğĆĦèğāėħĄãęĨüğĆĚħĐąĥ ĢüĠøŇĈēþĿĠĈēğþŎüčĕğĎøěâĕĆøĕąĢüĐĔü÷Ĕýøňüĥ ÷ĔèüĔĨüâĕĆāĔõüĕ ąĕøňĕüĄēğĆĦèĢĎĄŇĥ éęè÷ĬĕğüėüĐąŇĕèģĄŇĎąě÷ąĔĨè ĢüĠøŇĈēþĿéēĄĘąĕøňĕüĄēğĆĦèĐĐâčĜŇúňĐèøĈĕ÷ĎĈĕąøĬĕĆĔý ġ÷ąğêāĕēąĕ âĈěŇĄ targeted agents þŌééěýĔüąĔèĄĘąĕøňĕüĄēğĆĦè targeted agents ĐĘâĎĈĕąëüė÷úĘħĐąĜŇĢüãĔĨüøĐüâĕĆĊėéĔą ğëŇü cyclin inhibitors ĠĈēøňĕü cyclin- dependent kinase inhibitors, angiogenesis inhibitor, metalloproteinase inhibitor, cyclo-oxygenase 2-inhibitors, telomerase inhibitors, antisense oligonucleotides, farnesyl transferase inhibitors ĠĈēĄĘåĊĕĄāąĕąĕĄĢüâĕĆāĔõüĕąĕĢĎĄŇéĕâāĚëčĄěüģāĆġ÷ąĐĕċĔąãňĐĄĜĈéĕâčĄěüģāĆúĘÿħ čĄĢüøĬĕĆĔýąĕĆĔâČĕ ĄēğĆĦèãĐèâĕĆĠāúąŋúĕèğĈĚĐâ ĢüþŌééěýĔüĄĘãňĐĄĜĈâĕĆċęâČĕĢüĎňĐèþñėýĔøėąĚüąĔüćúûėīãĐèāĚëčĄěüģāĆ čĕĆĐĕĎĕĆ ĠĈē čĕĆčâĔ÷éĕâāĚëýĕèëüė÷ĊŇĕčĕĄĕĆùğĆŇèâĕĆøĕąãĐèğìĈĈŋĄēğĆĦè13 ğëŇü flavonoids ãĄėĨü ğĄĈĦ÷ĐèěŇü ğĄĈĦ÷āĚëøĆēâĜĈùĔħĊ 55


čŇèğčĆėĄâĕĆúĬĕèĕü p53 čĕĆčâĔ÷éĕâĈĜâğ÷ĚĐąĐĐâćúûėīĈ÷âĕĆčĆňĕèčĕĆ cyclin A ĠĈēčŇèğčĆėĄâĕĆøĕąãĐèğìĈĈŋġ÷ą âĆēøěňüğĐüģìĄŋ caspases čĕĆčâĔ÷éĕâĆĕâøĔèâěą (Angelica sinensis) ğĆŇèâĕĆøĕąãĐèğìĈĈŋĄēğĆĦèġ÷ąâĕĆâĆēøěňü ğĐüģìĄŋ caspase 9 ĠĈē 3 éęèĐĕéĢëňğþŎüğĎøěÿĈĐûėýĕąâĕĆĢëňčĄěüģāĆĎĆĚĐÿĈėøăĔöôŋğčĆėĄĐĕĎĕĆğāĚħĐâĕĆþŃĐèâĔüâĕĆ ğâė÷ĄēğĆĦèģ÷ň ĠĈēüĬĕģþčĜŇâĕĆāĔõüĕąĕøňĕüĄēğĆĦèëüė÷ĢĎĄŇĥ ĢüĐüĕåø ğĐâčĕĆĐňĕèĐėè 1. ĊĆëĔą ĆĔøüûĆĕûĆ, ĄûěĆč āèČŋĈėãėøĄèåĈ, ćúĔąĊĆĆö ġøʼnēúĐè, ĠĈēåöē. øĬĕĆĕâĕĆĆĔâČĕġĆåĄēğĆĦè āėĄāėīåĆĔĨèúĘħ 1 âĆěèğúāĄĎĕüåĆ: ġđĈĈėčøėâāĔýĈėčëėħè, 2541: 1-65. 2. Rang HP, Dale MM, Ritter JM et alCancer chemotherapy. In: Pharmacology, 5th ed. London : Livingstone. 2003: 693-709. 3. Byrd JC, Kitada S, Flinn IW, et al. The mechanism of tumor cell clearance by rituximab in vivo in patients with B-cell chronic lymphocytic leukemia: evidence of caspase activation and apoptosis induction. Blood, 1 February 2002; 99 (3): 1038-43. 4. Herceptin® (trastuzumab) mechanism of action. Available at http://www.herceptin.erceptin/professional/about/moa.jsp Accessed May 15, 2006. 5. Compath® (Alemtuzumab).prescribing information. Available at http://www.berlex.com/html/products/pi/Campath_PI.pdf. Accessed May 15, 2006. 6. Avastin (bevacizumab). Mechanism of action. Available at http://www.avastin.com/avastin/moaPro.m. Accessed May 15, 2006. 7. Erbitux (cetuximib) full prescribing information. Available at http://www.erbitux.com/erbitux/home/portal.jsp?BV_UseBVCookie=Yes. Accessed May 15, 2006. 8. Drug approved by FDA, Zevalin (ibritremomab). Available at http://centerwatch.com/patient/drugs/dru762html. Accessed May 20, 2006. 9. Lynch TJ, Bell DW, Sordella R, et al. Activating mutations in the epidermal growth factor receptor underlying responsiveness of non-small-cell lung cancer to gefitinib. N Engl J Med 2004; 350: 2129-39. 10. Jänne PA. EGFR mutations predict response to EGFR inhibitors: now what? Presented during “EGFR mutations predict response to gefitinib – now what?” session at ASCO 2004. Available at : http://www.asco.org/ac/1,1003,_12-002511-00_18-0026-00_1900116194,00.asp. Accessed May 10, 2006. 11. Okada M, Adachi S, Imai T, et al. A novel mechanism for imatinib mesylate-induced cell death of BCR-ABL-positive human leukemic cells: caspase-independent, necrosis-like programmed cell death mediated by serine protease activity . Blood, 2004; 103(6) : 2299-2307. Available at http://www.bloodjournal.org /cgi/content/short/2003-05-1605v1. Accessed May 15,2006. 12. Velcade® (bortezomib) for injection. Available at http: rxlist.com/cgi/generic 3/velcade.html. Accessed May 24, 2006. 23. 13. Kummalue T. Molecular mechanism of herbs in human lung cancer cells. J Med. Assoc. 88 (11). 2005: 1725-34.

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1. Over expression j•o gene §|¬•šp†‚§¤sÖ‰˜¤‹«o 6. i¨iiš‹••iŒ€œ°j•o Rituximab ? ¤}Ӛ‰ ? â. éĔýâĔý CD20 â. Rb ã. Bax gene ã. éĔýâĔý HER2 å HER2 gene è. P53 gene å. éĔýâĔý CD52 é. Rb ĠĈē p53 gene è. éĔýâĔý kinase domain é. éĔýâĔý caspases 2. jӕlš‰ ¨‰Ò~¡i}ӕo ¤i¬Ši™‚rœŠš¤sÖ‰˜¤‹«o ? â. ëĘĊġĄğĈâěĈúĘħčŇèğčĆėĄâĕĆĠāĆŇâĆēéĕąãĐèğìĈĈŋ åĚĐ matrix 7. i¨iiš‹••iŒ€œ°j•o Imatinib ? metalloproteinase â. éĔýâĔý CD20 ã. ĢüğüĚĨĐğąĚħĐĄēğĆĦèéēþĆēâĐý÷ňĊąğìĈĈŋúĘħĄĘĐĕąěĠøâøŇĕèâĔü ã. éĔýâĔý HER2 å. âĕĆâĈĕąāĔüûěŋãĐè RAS gene ģĄŇğâĘħąĊãňĐèâĕĆğâė÷ĄēğĆĦè å. éĔýâĔý CD52 è. âĕĆâĈĕąāĔüûěŋãĐè tumor suppressor gene ĠĈē protoè. éĔýâĔý kinase domain oncogene úĬĕĢĎňğìĈĈŋþâøėâĈĕąğþŎüğìĈĈŋĄēğĆĦè é. éĔýâĔý caspases é. ëĘĊġĄğĈâěĈúĘåħ ĊýåěĄĊèéĆëĘĊøė ãĐèğìĈĈŋĠĈēéĔ÷ğþŎü positive regulators åĚĐ cyclins ĠĈē cyclin dependent kinase 8. ’š‹’i™|pši…………¬‰Œ€œ°±ššŠ¤sÖ‰˜¤‹«o¦|Šiš‹i‹˜} Ӂ ¤•¨s‰Ö caspases sž¬o¤ƒÚ¤•¨s‰Ö’±šl™u§i‹˜‚iš‹ 3. ˆš˜§|¬¤ƒÚ’š¤“} pšiiš‹§rÓ¤l‰‚±š‚™|¤†ï•iš‹‹™i‘š‰˜¤‹«o }šŠj•o¤sÖ ? pžo¤ƒÚ¤“} §“Ó„¡ÓƒÍŠ•šp}œ|¤rŸ­•oҚŠ ? â. ğĄĈĦ÷ĐèěŇü â. Thrombocytopenia ã. Anemia ã. ĈĜâğ÷ĚĐą å. Granulocytosis è. Agranulocytosis å. ğĄĈĦ÷ĐèěŇüĠĈēĈĜâğ÷ĚĐą é. Neutropenia è. ĈĜâğ÷ĚĐąĠĈēøĔèâěą é. ğĄĈĦ÷ĐèěŇü ĈĜâğ÷ĚĐą ĠĈēøĔèâěą 4. ~Ӛ’‰‰ }xœ šiš‹¤p‹œuj•o¤sÖ‰˜¤‹«o¤iœ|pši overexpression j•o epidermal growth factor receptor Šš§jӕ§| 9. Chronic myelocytic leukemia •šp¤iœ|iš‹išŠ†™€Ö  j•oŠ§| ? ’š‰š‹~Š™‚Š™o­ signal transduction j•o tyrosine kinase â. Rb ã. Abl gene j•o receptor ‰œ§“Ó¤iœ| autophosphorylation ±š§“Ó¨‰Ò‰ å. HER2 gene è. P53 gene iš‹±š’Òo’™uuš{iš‹’‹Óšo¦ƒ‹}¬’Òo¤’‹œ‰iš‹¤p‹œuj•o é. Rb ĠĈē p53 gene ¤sÖ‰˜¤‹«o ? â. Rituximab ã. Franesylase inhibitor 10. B cell leukemia rœ|¬}‹p†‚ CD52 •šp‹™i‘š|ӏŠ å. Alemtuzumab è. Trastuzumab targeted agent rœ|§| ? é. Gefitinib â. Rituximab ã. Franesylase inhibitor 5. i¨iiš‹••iŒ€œ°j•o trastuzumab lŸ•jӕ§| ? â. éĔýâĔý caspase ã. éĔýâĔý HER2 å. Alemtuzumab å. éĔýâĔý CD52 è. éĔýâĔý kinase domain è. Trastuzumab é. éĔýâĔý CD20 é. Gefitinib 58


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